%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R 62 0 R 71 0 R 157 0 R 215 0 R 265 0 R 267 0 R ] /Count 7 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R /F3 10 0 R /F4 11 0 R >> /XObject << /I1 12 0 R /I2 13 0 R /I3 66 0 R /I4 167 0 R /I5 178 0 R >> >> /MediaBox [0.000 0.000 612.000 792.000] >> endobj 4 0 obj [/PDF /Text /ImageC ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20180723051716+00'00') /ModDate (D:20180723051716+00'00') /Title (Disasters at Mass Gatherings: Lessons from History PLOS Currents Disasters) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Annots [ 14 0 R 16 0 R 18 0 R 20 0 R 22 0 R 24 0 R 26 0 R 28 0 R 30 0 R 32 0 R 34 0 R 36 0 R 38 0 R 40 0 R 42 0 R 44 0 R 46 0 R 48 0 R 50 0 R 52 0 R 54 0 R 56 0 R 58 0 R 60 0 R ] /Contents 7 0 R >> endobj 7 0 obj << /Length 21658 >> stream q 375.000 0 0 39.000 222.000 738.000 cm /I2 Do Q q 15.000 709.302 577.500 28.698 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(Disasters at Mass Gatherings: Lessons from History)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 700.036 Td /F3 9.8 Tf [(January 31, 2012)] TJ ET BT 88.388 700.036 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 93.263 700.036 Td /F3 9.8 Tf [(Research Article)] TJ ET 0.271 0.267 0.267 rg BT 26.250 688.195 Td /F1 9.8 Tf [(, )] TJ ET BT 31.671 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 37.092 688.195 Td /F1 9.8 Tf [(Lee Soomaroo)] TJ ET 0.271 0.267 0.267 rg BT 101.042 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 106.463 688.195 Td /F1 9.8 Tf [(Virginia Murray)] TJ ET 0.271 0.267 0.267 rg BT 26.250 676.290 Td /F1 9.8 Tf [(Soomaroo L, Murray V. Disasters at Mass Gatherings: Lessons from History. PLOS Currents Disasters. 2012 Jan 31 . Edition )] TJ ET BT 569.198 676.290 Td /F1 9.8 Tf [(1. )] TJ ET BT 26.250 664.386 Td /F1 9.8 Tf [(doi: 10.1371/currents.RRN1301.)] TJ ET q 15.000 26.263 577.500 635.741 re W n 0.271 0.267 0.267 rg BT 26.250 635.283 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 615.329 Td /F1 9.8 Tf [(Introduction: Reviews of mass gathering events have traditionally concentrated on crowd variables that affect the level and type )] TJ ET BT 26.250 603.424 Td /F1 9.8 Tf [(of medical care needed. Crowd disasters at mass gathering events have not been fully researched and this review examines )] TJ ET BT 26.250 591.519 Td /F1 9.8 Tf [(these aiming to provide future suggestions for event organisers, medical resource planners, and emergency services, including )] TJ ET BT 26.250 579.615 Td /F1 9.8 Tf [(local hospital emergency departments.)] TJ ET BT 26.250 560.210 Td /F1 9.8 Tf [(Methods: A review was conducted using computerised data bases: MEDLINE, The Cochrane Library, HMIC and EMBASE, with )] TJ ET BT 26.250 548.305 Td /F1 9.8 Tf [(Google used to widen the search beyond peer-reviewed publications, to identify grey literature. All peer-review literature articles )] TJ ET BT 26.250 536.400 Td /F1 9.8 Tf [(found containing information pertaining to lessons identified from mass gathering crowd disasters were analysed and reviewed. )] TJ ET BT 26.250 524.496 Td /F1 9.8 Tf [(Disasters occurring in extreme weather events, and environmental leading to participant illness were not included. These )] TJ ET BT 26.250 512.591 Td /F1 9.8 Tf [(articles were read, analysed, abstracted and summarised.)] TJ ET BT 26.250 493.186 Td /F1 9.8 Tf [(Results: 156 articles from literature search were found detailing mass gathering disasters identified from 1971 2011. With only )] TJ ET BT 26.250 481.281 Td /F1 9.8 Tf [(21 cases found within peer-review literature. Twelve events were further documented as a case reports. Five events were )] TJ ET BT 26.250 469.377 Td /F1 9.8 Tf [(examined as review articles while four events underwent commissioned inquiries. Analysis of cases were categorised in to )] TJ ET BT 26.250 457.472 Td /F1 9.8 Tf [(crowd control, event access, fire safety, medical preparedness and emergency response.)] TJ ET BT 26.250 438.067 Td /F1 9.8 Tf [(Conclusions: Mass gathering events have an enormous potential to place a severe strain on the local health care system, and a )] TJ ET BT 26.250 426.162 Td /F1 9.8 Tf [(mixture of high crowd density, restricted points of access, poor fire safety, minimum crowd control and lack of on-site medical )] TJ ET BT 26.250 414.258 Td /F1 9.8 Tf [(care can lead to problems that end in disaster.)] TJ ET BT 26.250 377.655 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 357.701 Td /F1 9.8 Tf [(2 Months out-of-placement training \(OOPT\) secondment to the Health Protection Agency UK for Dr Soomaroo kindly funded by )] TJ ET BT 26.250 345.796 Td /F1 9.8 Tf [(HPA medical trainees fund.)] TJ ET BT 26.250 316.694 Td /F4 12.0 Tf [(Introduction)] TJ ET BT 26.250 296.739 Td /F1 9.8 Tf [(Mass gatherings require the provision of medical services for large populations who have assembled under unusual )] TJ ET BT 26.250 284.835 Td /F1 9.8 Tf [(circumstances. Mass gatherings, including scheduled events in sports facilities, air shows, rock concerts, outdoor celebrations, )] TJ ET BT 26.250 272.930 Td /F1 9.8 Tf [(and visits by dignitaries, vary in their complexity and demand for medical services.)] TJ ET BT 26.250 253.525 Td /F1 9.8 Tf [(The definition of a mass gathering itself is not without debate. The National Association of EMS Physicians \(NAEMSP\) defined it )] TJ ET BT 26.250 241.620 Td /F1 9.8 Tf [(as: Organized emergency health services provided for spectators and participants at events in which at least 1000 persons are )] TJ ET BT 26.250 229.716 Td /F1 9.8 Tf [(gathered at a specific location for a defined period of time )] TJ ET 0.267 0.267 0.267 rg BT 276.630 229.716 Td /F1 9.8 Tf [([1])] TJ ET 0.271 0.267 0.267 rg BT 287.472 229.716 Td /F1 9.8 Tf [( , while the WHO )] TJ ET 0.267 0.267 0.267 rg BT 363.327 229.716 Td /F1 9.8 Tf [([2])] TJ ET 0.271 0.267 0.267 rg BT 374.169 229.716 Td /F1 9.8 Tf [( describes it as An organised or unplanned )] TJ ET BT 26.250 217.811 Td /F1 9.8 Tf [(event where the number of people attending is sufficient to strain the planning and response resources of the community, state )] TJ ET BT 26.250 205.906 Td /F1 9.8 Tf [(or nation hosting the event. The United Nations International Strategy for Disaster Reduction \(UNISDR\) defines a disaster as a )] TJ ET BT 26.250 194.001 Td /F1 9.8 Tf [(serious disruption of the functioning of a community or a society involving widespread human, material, economic or )] TJ ET BT 26.250 182.097 Td /F1 9.8 Tf [(environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own )] TJ ET BT 26.250 170.192 Td /F1 9.8 Tf [(resources. In the context of this review of mass gathering incidents, a disaster is to be considered as a calamitous event )] TJ ET BT 26.250 158.287 Td /F1 9.8 Tf [(occurring suddenly and causing great loss of life or damage to surroundings.)] TJ ET BT 26.250 138.882 Td /F1 9.8 Tf [(Historically, peer-reviewed literature has concentrated on crowd variables that affect the level and types of medical need at a )] TJ ET BT 26.250 126.978 Td /F1 9.8 Tf [(mass gathering event )] TJ ET 0.267 0.267 0.267 rg BT 122.171 126.978 Td /F1 9.8 Tf [([3])] TJ ET 0.271 0.267 0.267 rg BT 133.012 126.978 Td /F1 9.8 Tf [( , studying patient presentation rates of illness and minor injuries, while also providing possible )] TJ ET BT 26.250 115.073 Td /F1 9.8 Tf [(prediction tools for first-aid providers and local hospitals )] TJ ET 0.267 0.267 0.267 rg BT 269.005 115.073 Td /F1 9.8 Tf [([4])] TJ ET 0.271 0.267 0.267 rg BT 279.848 115.073 Td /F1 9.8 Tf [( . However there is a lack of available evidence analysing crowd )] TJ ET BT 26.250 103.168 Td /F1 9.8 Tf [(disasters at mass gathering events providing future suggestions for event organisers, medical resource planners, and )] TJ ET BT 26.250 91.263 Td /F1 9.8 Tf [(emergency services, including local hospital emergency departments.)] TJ ET Q q 15.000 709.302 577.500 28.698 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(Disasters at Mass Gatherings: Lessons from History)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 700.036 Td /F3 9.8 Tf [(January 31, 2012)] TJ ET BT 88.388 700.036 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 93.263 700.036 Td /F3 9.8 Tf [(Research Article)] TJ ET 0.271 0.267 0.267 rg BT 26.250 688.195 Td /F1 9.8 Tf [(, )] TJ ET BT 31.671 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 37.092 688.195 Td /F1 9.8 Tf [(Lee Soomaroo)] TJ ET 0.271 0.267 0.267 rg BT 101.042 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 106.463 688.195 Td /F1 9.8 Tf [(Virginia Murray)] TJ ET 0.271 0.267 0.267 rg BT 26.250 676.290 Td /F1 9.8 Tf [(Soomaroo L, Murray V. Disasters at Mass Gatherings: Lessons from History. PLOS Currents Disasters. 2012 Jan 31 . Edition )] TJ ET BT 569.198 676.290 Td /F1 9.8 Tf [(1. )] TJ ET BT 26.250 664.386 Td /F1 9.8 Tf [(doi: 10.1371/currents.RRN1301.)] TJ ET q 15.000 26.263 577.500 635.741 re W n 0.271 0.267 0.267 rg BT 26.250 635.283 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 615.329 Td /F1 9.8 Tf [(Introduction: Reviews of mass gathering events have traditionally concentrated on crowd variables that affect the level and type )] TJ ET BT 26.250 603.424 Td /F1 9.8 Tf [(of medical care needed. Crowd disasters at mass gathering events have not been fully researched and this review examines )] TJ ET BT 26.250 591.519 Td /F1 9.8 Tf [(these aiming to provide future suggestions for event organisers, medical resource planners, and emergency services, including )] TJ ET BT 26.250 579.615 Td /F1 9.8 Tf [(local hospital emergency departments.)] TJ ET BT 26.250 560.210 Td /F1 9.8 Tf [(Methods: A review was conducted using computerised data bases: MEDLINE, The Cochrane Library, HMIC and EMBASE, with )] TJ ET BT 26.250 548.305 Td /F1 9.8 Tf [(Google used to widen the search beyond peer-reviewed publications, to identify grey literature. All peer-review literature articles )] TJ ET BT 26.250 536.400 Td /F1 9.8 Tf [(found containing information pertaining to lessons identified from mass gathering crowd disasters were analysed and reviewed. )] TJ ET BT 26.250 524.496 Td /F1 9.8 Tf [(Disasters occurring in extreme weather events, and environmental leading to participant illness were not included. These )] TJ ET BT 26.250 512.591 Td /F1 9.8 Tf [(articles were read, analysed, abstracted and summarised.)] TJ ET BT 26.250 493.186 Td /F1 9.8 Tf [(Results: 156 articles from literature search were found detailing mass gathering disasters identified from 1971 2011. With only )] TJ ET BT 26.250 481.281 Td /F1 9.8 Tf [(21 cases found within peer-review literature. Twelve events were further documented as a case reports. Five events were )] TJ ET BT 26.250 469.377 Td /F1 9.8 Tf [(examined as review articles while four events underwent commissioned inquiries. Analysis of cases were categorised in to )] TJ ET BT 26.250 457.472 Td /F1 9.8 Tf [(crowd control, event access, fire safety, medical preparedness and emergency response.)] TJ ET BT 26.250 438.067 Td /F1 9.8 Tf [(Conclusions: Mass gathering events have an enormous potential to place a severe strain on the local health care system, and a )] TJ ET BT 26.250 426.162 Td /F1 9.8 Tf [(mixture of high crowd density, restricted points of access, poor fire safety, minimum crowd control and lack of on-site medical )] TJ ET BT 26.250 414.258 Td /F1 9.8 Tf [(care can lead to problems that end in disaster.)] TJ ET BT 26.250 377.655 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 357.701 Td /F1 9.8 Tf [(2 Months out-of-placement training \(OOPT\) secondment to the Health Protection Agency UK for Dr Soomaroo kindly funded by )] TJ ET BT 26.250 345.796 Td /F1 9.8 Tf [(HPA medical trainees fund.)] TJ ET BT 26.250 316.694 Td /F4 12.0 Tf [(Introduction)] TJ ET BT 26.250 296.739 Td /F1 9.8 Tf [(Mass gatherings require the provision of medical services for large populations who have assembled under unusual )] TJ ET BT 26.250 284.835 Td /F1 9.8 Tf [(circumstances. Mass gatherings, including scheduled events in sports facilities, air shows, rock concerts, outdoor celebrations, )] TJ ET BT 26.250 272.930 Td /F1 9.8 Tf [(and visits by dignitaries, vary in their complexity and demand for medical services.)] TJ ET BT 26.250 253.525 Td /F1 9.8 Tf [(The definition of a mass gathering itself is not without debate. The National Association of EMS Physicians \(NAEMSP\) defined it )] TJ ET BT 26.250 241.620 Td /F1 9.8 Tf [(as: Organized emergency health services provided for spectators and participants at events in which at least 1000 persons are )] TJ ET BT 26.250 229.716 Td /F1 9.8 Tf [(gathered at a specific location for a defined period of time )] TJ ET 0.267 0.267 0.267 rg BT 276.630 229.716 Td /F1 9.8 Tf [([1])] TJ ET 0.271 0.267 0.267 rg BT 287.472 229.716 Td /F1 9.8 Tf [( , while the WHO )] TJ ET 0.267 0.267 0.267 rg BT 363.327 229.716 Td /F1 9.8 Tf [([2])] TJ ET 0.271 0.267 0.267 rg BT 374.169 229.716 Td /F1 9.8 Tf [( describes it as An organised or unplanned )] TJ ET BT 26.250 217.811 Td /F1 9.8 Tf [(event where the number of people attending is sufficient to strain the planning and response resources of the community, state )] TJ ET BT 26.250 205.906 Td /F1 9.8 Tf [(or nation hosting the event. The United Nations International Strategy for Disaster Reduction \(UNISDR\) defines a disaster as a )] TJ ET BT 26.250 194.001 Td /F1 9.8 Tf [(serious disruption of the functioning of a community or a society involving widespread human, material, economic or )] TJ ET BT 26.250 182.097 Td /F1 9.8 Tf [(environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own )] TJ ET BT 26.250 170.192 Td /F1 9.8 Tf [(resources. In the context of this review of mass gathering incidents, a disaster is to be considered as a calamitous event )] TJ ET BT 26.250 158.287 Td /F1 9.8 Tf [(occurring suddenly and causing great loss of life or damage to surroundings.)] TJ ET BT 26.250 138.882 Td /F1 9.8 Tf [(Historically, peer-reviewed literature has concentrated on crowd variables that affect the level and types of medical need at a )] TJ ET BT 26.250 126.978 Td /F1 9.8 Tf [(mass gathering event )] TJ ET 0.267 0.267 0.267 rg BT 122.171 126.978 Td /F1 9.8 Tf [([3])] TJ ET 0.271 0.267 0.267 rg BT 133.012 126.978 Td /F1 9.8 Tf [( , studying patient presentation rates of illness and minor injuries, while also providing possible )] TJ ET BT 26.250 115.073 Td /F1 9.8 Tf [(prediction tools for first-aid providers and local hospitals )] TJ ET 0.267 0.267 0.267 rg BT 269.005 115.073 Td /F1 9.8 Tf [([4])] TJ ET 0.271 0.267 0.267 rg BT 279.848 115.073 Td /F1 9.8 Tf [( . However there is a lack of available evidence analysing crowd )] TJ ET BT 26.250 103.168 Td /F1 9.8 Tf [(disasters at mass gathering events providing future suggestions for event organisers, medical resource planners, and )] TJ ET BT 26.250 91.263 Td /F1 9.8 Tf [(emergency services, including local hospital emergency departments.)] TJ ET Q q 15.000 709.302 577.500 28.698 re W n 0.267 0.267 0.267 rg BT 15.000 718.042 Td /F2 21.0 Tf [(Disasters at Mass Gatherings: Lessons from History)] TJ ET Q 0.271 0.267 0.267 rg BT 15.000 700.036 Td /F3 9.8 Tf [(January 31, 2012)] TJ ET BT 88.388 700.036 Td /F3 9.8 Tf [()] TJ ET 0.267 0.267 0.267 rg BT 93.263 700.036 Td /F3 9.8 Tf [(Research Article)] TJ ET 0.271 0.267 0.267 rg BT 26.250 688.195 Td /F1 9.8 Tf [(, )] TJ ET BT 31.671 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 37.092 688.195 Td /F1 9.8 Tf [(Lee Soomaroo)] TJ ET 0.271 0.267 0.267 rg BT 101.042 688.195 Td /F1 9.8 Tf [(, )] TJ ET 0.267 0.267 0.267 rg BT 106.463 688.195 Td /F1 9.8 Tf [(Virginia Murray)] TJ ET 0.271 0.267 0.267 rg BT 26.250 676.290 Td /F1 9.8 Tf [(Soomaroo L, Murray V. Disasters at Mass Gatherings: Lessons from History. PLOS Currents Disasters. 2012 Jan 31 . Edition )] TJ ET BT 569.198 676.290 Td /F1 9.8 Tf [(1. )] TJ ET BT 26.250 664.386 Td /F1 9.8 Tf [(doi: 10.1371/currents.RRN1301.)] TJ ET q 15.000 26.263 577.500 635.741 re W n 0.271 0.267 0.267 rg BT 26.250 635.283 Td /F4 12.0 Tf [(Abstract)] TJ ET BT 26.250 615.329 Td /F1 9.8 Tf [(Introduction: Reviews of mass gathering events have traditionally concentrated on crowd variables that affect the level and type )] TJ ET BT 26.250 603.424 Td /F1 9.8 Tf [(of medical care needed. Crowd disasters at mass gathering events have not been fully researched and this review examines )] TJ ET BT 26.250 591.519 Td /F1 9.8 Tf [(these aiming to provide future suggestions for event organisers, medical resource planners, and emergency services, including )] TJ ET BT 26.250 579.615 Td /F1 9.8 Tf [(local hospital emergency departments.)] TJ ET BT 26.250 560.210 Td /F1 9.8 Tf [(Methods: A review was conducted using computerised data bases: MEDLINE, The Cochrane Library, HMIC and EMBASE, with )] TJ ET BT 26.250 548.305 Td /F1 9.8 Tf [(Google used to widen the search beyond peer-reviewed publications, to identify grey literature. All peer-review literature articles )] TJ ET BT 26.250 536.400 Td /F1 9.8 Tf [(found containing information pertaining to lessons identified from mass gathering crowd disasters were analysed and reviewed. )] TJ ET BT 26.250 524.496 Td /F1 9.8 Tf [(Disasters occurring in extreme weather events, and environmental leading to participant illness were not included. These )] TJ ET BT 26.250 512.591 Td /F1 9.8 Tf [(articles were read, analysed, abstracted and summarised.)] TJ ET BT 26.250 493.186 Td /F1 9.8 Tf [(Results: 156 articles from literature search were found detailing mass gathering disasters identified from 1971 2011. With only )] TJ ET BT 26.250 481.281 Td /F1 9.8 Tf [(21 cases found within peer-review literature. Twelve events were further documented as a case reports. Five events were )] TJ ET BT 26.250 469.377 Td /F1 9.8 Tf [(examined as review articles while four events underwent commissioned inquiries. Analysis of cases were categorised in to )] TJ ET BT 26.250 457.472 Td /F1 9.8 Tf [(crowd control, event access, fire safety, medical preparedness and emergency response.)] TJ ET BT 26.250 438.067 Td /F1 9.8 Tf [(Conclusions: Mass gathering events have an enormous potential to place a severe strain on the local health care system, and a )] TJ ET BT 26.250 426.162 Td /F1 9.8 Tf [(mixture of high crowd density, restricted points of access, poor fire safety, minimum crowd control and lack of on-site medical )] TJ ET BT 26.250 414.258 Td /F1 9.8 Tf [(care can lead to problems that end in disaster.)] TJ ET BT 26.250 377.655 Td /F4 12.0 Tf [(Funding Statement)] TJ ET BT 26.250 357.701 Td /F1 9.8 Tf [(2 Months out-of-placement training \(OOPT\) secondment to the Health Protection Agency UK for Dr Soomaroo kindly funded by )] TJ ET BT 26.250 345.796 Td /F1 9.8 Tf [(HPA medical trainees fund.)] TJ ET BT 26.250 316.694 Td /F4 12.0 Tf [(Introduction)] TJ ET BT 26.250 296.739 Td /F1 9.8 Tf [(Mass gatherings require the provision of medical services for large populations who have assembled under unusual )] TJ ET BT 26.250 284.835 Td /F1 9.8 Tf [(circumstances. Mass gatherings, including scheduled events in sports facilities, air shows, rock concerts, outdoor celebrations, )] TJ ET BT 26.250 272.930 Td /F1 9.8 Tf [(and visits by dignitaries, vary in their complexity and demand for medical services.)] TJ ET BT 26.250 253.525 Td /F1 9.8 Tf [(The definition of a mass gathering itself is not without debate. The National Association of EMS Physicians \(NAEMSP\) defined it )] TJ ET BT 26.250 241.620 Td /F1 9.8 Tf [(as: Organized emergency health services provided for spectators and participants at events in which at least 1000 persons are )] TJ ET BT 26.250 229.716 Td /F1 9.8 Tf [(gathered at a specific location for a defined period of time )] TJ ET 0.267 0.267 0.267 rg BT 276.630 229.716 Td /F1 9.8 Tf [([1])] TJ ET 0.271 0.267 0.267 rg BT 287.472 229.716 Td /F1 9.8 Tf [( , while the WHO )] TJ ET 0.267 0.267 0.267 rg BT 363.327 229.716 Td /F1 9.8 Tf [([2])] TJ ET 0.271 0.267 0.267 rg BT 374.169 229.716 Td /F1 9.8 Tf [( describes it as An organised or unplanned )] TJ ET BT 26.250 217.811 Td /F1 9.8 Tf [(event where the number of people attending is sufficient to strain the planning and response resources of the community, state )] TJ ET BT 26.250 205.906 Td /F1 9.8 Tf [(or nation hosting the event. The United Nations International Strategy for Disaster Reduction \(UNISDR\) defines a disaster as a )] TJ ET BT 26.250 194.001 Td /F1 9.8 Tf [(serious disruption of the functioning of a community or a society involving widespread human, material, economic or )] TJ ET BT 26.250 182.097 Td /F1 9.8 Tf [(environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own )] TJ ET BT 26.250 170.192 Td /F1 9.8 Tf [(resources. In the context of this review of mass gathering incidents, a disaster is to be considered as a calamitous event )] TJ ET BT 26.250 158.287 Td /F1 9.8 Tf [(occurring suddenly and causing great loss of life or damage to surroundings.)] TJ ET BT 26.250 138.882 Td /F1 9.8 Tf [(Historically, peer-reviewed literature has concentrated on crowd variables that affect the level and types of medical need at a )] TJ ET BT 26.250 126.978 Td /F1 9.8 Tf [(mass gathering event )] TJ ET 0.267 0.267 0.267 rg BT 122.171 126.978 Td /F1 9.8 Tf [([3])] TJ ET 0.271 0.267 0.267 rg BT 133.012 126.978 Td /F1 9.8 Tf [( , studying patient presentation rates of illness and minor injuries, while also providing possible )] TJ ET BT 26.250 115.073 Td /F1 9.8 Tf [(prediction tools for first-aid providers and local hospitals )] TJ ET 0.267 0.267 0.267 rg BT 269.005 115.073 Td /F1 9.8 Tf [([4])] TJ ET 0.271 0.267 0.267 rg BT 279.848 115.073 Td /F1 9.8 Tf [( . However there is a lack of available evidence analysing crowd )] TJ ET BT 26.250 103.168 Td /F1 9.8 Tf [(disasters at mass gathering events providing future suggestions for event organisers, medical resource planners, and )] TJ ET BT 26.250 91.263 Td /F1 9.8 Tf [(emergency services, including local hospital emergency departments.)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(1)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET 0.39 w 1 J 1 j Q endstream endobj 8 0 obj << /Type /Font /Subtype /Type1 /Name /F1 /BaseFont /Helvetica /Encoding /WinAnsiEncoding >> endobj 9 0 obj << /Type /Font /Subtype /Type1 /Name /F2 /BaseFont /Times-Bold /Encoding /WinAnsiEncoding >> endobj 10 0 obj << /Type /Font /Subtype /Type1 /Name /F3 /BaseFont /Times-Italic /Encoding /WinAnsiEncoding >> endobj 11 0 obj << /Type /Font /Subtype /Type1 /Name /F4 /BaseFont /Helvetica-Bold /Encoding /WinAnsiEncoding >> endobj 12 0 obj << /Type /XObject /Subtype /Image /Width 500 /Height 52 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 1 /Columns 500 /BitsPerComponent 8>> /ColorSpace /DeviceGray /BitsPerComponent 8 /Length 144>> stream x1 0 'ݲ؎"e{dzAdzAdzAdzAdzAdzAdzAdzAdzAdzAdzAdzAtlM0\ endstream endobj 13 0 obj << /Type /XObject /Subtype /Image /Width 500 /Height 52 /SMask 12 0 R /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 500 /BitsPerComponent 8>> /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 3627>> stream x?b!/w N BU!@rܥ>L%|"ɾeB~qbϧG0 0 0 ü<,a ,a ,a /)܋( daKnW>'IR2 0x1ͽ{0 Z4= 4M޶mY}'IĖ2 0ָML}GQ48Iy>i("u>s6ne0 YfB;S}b 5ba,ZP՚ћuFڶ= 0{ǤbA!>m{wwW׵ApssDZdU,K:fs_׿___qykQbfMii{$̂>}JdB um{Lh'پy2c\ifZypE|,Uݝ,h4ڶ],R*\U-rQ9l PUUQ#G80aef_-mI*gߋlil-d:5ec]RUa0\ͼ$ ֌8jE%4BH\m=ϣfY )!vDL^)4axt=3*E<' _?>>.7DYt]׆0gqwр,ajmۢ(HMB$ [ U5;gfw`2R]u]GQD0g[Tt:a1J#,AU}0hwb>&8V~*ȀIH fuiah aMl7\:\>|,L5w(YqOFsoBy|<3^=6.ym۾%)~`XHnݰ‹IDs'oZ7In}wV|C%H{lDsDQ6]4jcЊͭ;*ٶv&A.09e(ji2btXɄy4?!ZEI"+Yɲy%'hZch@C+q,U1TA+FEe_R18;z.􃰢c ( H| $I.hy {ss&` 26:#(RuGQmZtJӅ˲csоj$}3#rl& j }>  ]x] ъ|G[1lfu ϛIaVz0-mvy2h܉ေA^XD`b"W#ֵU{(Y BAaDL]z_ex6 (nMOÈ%֐m`04Ԝ0aℓ.*"^=KeY~-'iM``v,Z꺞fRf1c+! 85BX,HeEљ @N^ԚG`5p |!L]U).?"l5eFQŞu]ɍK'eW/o҆&(i VM_ = E/J,;sqq0 W>rM=gdќ陞qѼ:2X;.˲j#Ņ뺮fbi\ו.u݋1mgXEQꋋ q@P%~VL0%b`eF4M}'@Sp8v;FߊdY]@u[5 (96 V0~1Gj Ňg֏= >\'ͪ$yX`!dhq%I0fF5x]t,hRˮb"3鈰@'5ؽE2>GI@ KȲLrÿ*1ȰT5ffܱYjuqqC3v(uEsI'c^چ#X,hAk"ZH6`XPW,>}fY6t^C8,Fi#nica Jzlf0 >سX,)m_Bs' c oN c>TT'%x&ߘ fi$W܇g[@ mDZ7]:RQjƘ.ğ$:؝, s{HzxqZKmF|Ϗ~p7@ {1$Xu}p(ĉzZaJ%i&0L@#\}GaT~tTQ,asEOxhy.?,aC9oqE=MS9I%8~WmdG:agO\\$,yHg^Ab%Ĩ7Z}џd2!YmN0X-#*ڈ/&W4MAYT?3;f udJ 6%ag9IxINlȦ|[+ ٘{R0' uT?NP%A wD&1=4L&ĵg-G)+0*V} 62T75yiۣrѰڳ>$'?B'IeY0K1WH]NkiR m<˭XF.xaijT==}~&;ہHA7| \( s\? ~_{ޒ{ O?^AVtї~g~~mVfS XtU6wMUv8|xxG-ü[A܆m!g۾勜*N5,sP=0 cibCub=2xa? 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/Subtype /Link /A 61 0 R /Border [0 0 0] /H /I /Rect [ 269.0055 114.1711 279.8475 124.0917 ] >> endobj 61 0 obj << /Type /Action >> endobj 62 0 obj << /Type /Page /Parent 3 0 R /Annots [ 64 0 R 67 0 R 69 0 R ] /Contents 63 0 R >> endobj 63 0 obj << /Length 19102 >> stream 0.271 0.267 0.267 rg q 15.000 49.863 577.500 727.137 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(This review aims to analyse previous cases of disaster at mass gathering events, documenting the lessons identified, to provide )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(considerations when planning for future events. With careful assessment of mass gathering events as a whole it will be possible )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(to plan ahead for the potential number of attendees, consider health and safety aspects of planning for a mass gathering, plan )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(for potential disasters and decrease the risk of the happening, provide a more effective allocation of health resources.)] TJ ET BT 26.250 695.159 Td /F4 12.0 Tf [(Method)] TJ ET BT 26.250 675.205 Td /F1 9.8 Tf [(This literature review concentrates on crowd disasters at mass gathering events, focusing on predominantly on case reports and )] TJ ET BT 26.250 663.300 Td /F1 9.8 Tf [(literature reviews citing particular lessons identified from previous disasters.)] TJ ET BT 26.250 643.896 Td /F1 9.8 Tf [(A literature search was carried out using Medline, Cochrane, HMIC and Embase. A free-text search was also conducted using )] TJ ET BT 26.250 631.991 Td /F1 9.8 Tf [(Google to link mass gathering events to disaster incidents in order to widen the search beyond peer-reviewed publications )] TJ ET BT 26.250 620.086 Td /F1 9.8 Tf [(which included grey literature \(media reports, unpublished reports and commissioned inquiries\). All peer-review literature )] TJ ET BT 26.250 608.181 Td /F1 9.8 Tf [(articles found containing information pertaining to lessons identified from mass gathering crowd disasters were analysed and )] TJ ET BT 26.250 596.277 Td /F1 9.8 Tf [(reviewed. Articles describing disasters occurring in extreme weather events such as heat-related illness, and environmental )] TJ ET BT 26.250 584.372 Td /F1 9.8 Tf [(hazards leading to illness such as disease outbreak were not included. Citations within articles were further searched to identify )] TJ ET BT 26.250 572.467 Td /F1 9.8 Tf [(additional references that would inform this review.)] TJ ET BT 26.250 553.062 Td /F1 9.8 Tf [(Keywords: Mass Gatherings, Mass Gathering Medicine, Disasters, Sporting Events, Olympic Games, Festivals, Concerts, )] TJ ET BT 26.250 541.158 Td /F1 9.8 Tf [(Disaster, Stampede, Fire, Terrorism, Religious Gathering, Air Show.)] TJ ET BT 26.250 504.555 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 484.601 Td /F1 9.8 Tf [(In total, 156 reported mass gathering incidents from 1971 2011, were identified through literature search. While some reports )] TJ ET BT 26.250 472.696 Td /F1 9.8 Tf [(provided valuable information regarding mass gathering disaster occurrence, most cases were descriptive rather than analytical, )] TJ ET BT 26.250 460.791 Td /F1 9.8 Tf [(consequently very few literature reports \(only 21\) were found to inform subjects of lessons identified from disasters at mass )] TJ ET BT 26.250 448.887 Td /F1 9.8 Tf [(gathering events. 17 of these reports had been only reported in journal publications, with four reports having undergone )] TJ ET BT 26.250 436.982 Td /F1 9.8 Tf [(commissioned inquiries.)] TJ ET BT 26.250 417.577 Td /F1 9.8 Tf [(21 reported mass gathering incidents have been read, analysed, abstracted, referenced and complied in chronological order )] TJ ET BT 26.250 405.672 Td /F1 9.8 Tf [(and referenced. Main learning points have been identified and further categorised in to 5 key areas for further discussion:)] TJ ET 0.271 0.267 0.267 RG 40.337 389.235 m 40.337 389.682 40.154 390.126 39.838 390.442 c 39.522 390.758 39.078 390.942 38.631 390.942 c 38.185 390.942 37.741 390.758 37.425 390.442 c 37.109 390.126 36.925 389.682 36.925 389.235 c 36.925 388.789 37.109 388.345 37.425 388.029 c 37.741 387.713 38.185 387.529 38.631 387.529 c 39.078 387.529 39.522 387.713 39.838 388.029 c 40.154 388.345 40.337 388.789 40.337 389.235 c f BT 45.750 386.268 Td /F1 9.8 Tf [(Overcrowding and Crowd Control)] TJ ET 40.337 373.581 m 40.337 374.027 40.154 374.471 39.838 374.787 c 39.522 375.103 39.078 375.287 38.631 375.287 c 38.185 375.287 37.741 375.103 37.425 374.787 c 37.109 374.471 36.925 374.027 36.925 373.581 c 36.925 373.134 37.109 372.690 37.425 372.374 c 37.741 372.058 38.185 371.874 38.631 371.874 c 39.078 371.874 39.522 372.058 39.838 372.374 c 40.154 372.690 40.337 373.134 40.337 373.581 c f BT 45.750 370.613 Td /F1 9.8 Tf [(Event Access Points)] TJ ET 40.337 357.926 m 40.337 358.372 40.154 358.816 39.838 359.132 c 39.522 359.448 39.078 359.632 38.631 359.632 c 38.185 359.632 37.741 359.448 37.425 359.132 c 37.109 358.816 36.925 358.372 36.925 357.926 c 36.925 357.479 37.109 357.035 37.425 356.719 c 37.741 356.403 38.185 356.220 38.631 356.220 c 39.078 356.220 39.522 356.403 39.838 356.719 c 40.154 357.035 40.337 357.479 40.337 357.926 c f BT 45.750 354.958 Td /F1 9.8 Tf [(Fire Safety Measures)] TJ ET 40.337 342.271 m 40.337 342.718 40.154 343.162 39.838 343.478 c 39.522 343.793 39.078 343.977 38.631 343.977 c 38.185 343.977 37.741 343.793 37.425 343.478 c 37.109 343.162 36.925 342.718 36.925 342.271 c 36.925 341.824 37.109 341.380 37.425 341.064 c 37.741 340.749 38.185 340.565 38.631 340.565 c 39.078 340.565 39.522 340.749 39.838 341.064 c 40.154 341.380 40.337 341.824 40.337 342.271 c f BT 45.750 339.303 Td /F1 9.8 Tf [(Medical Preparedness)] TJ ET 40.337 326.616 m 40.337 327.063 40.154 327.507 39.838 327.823 c 39.522 328.139 39.078 328.323 38.631 328.323 c 38.185 328.323 37.741 328.139 37.425 327.823 c 37.109 327.507 36.925 327.063 36.925 326.616 c 36.925 326.170 37.109 325.726 37.425 325.410 c 37.741 325.094 38.185 324.910 38.631 324.910 c 39.078 324.910 39.522 325.094 39.838 325.410 c 40.154 325.726 40.337 326.170 40.337 326.616 c f BT 45.750 323.649 Td /F1 9.8 Tf [(Emergency Response)] TJ ET BT 26.250 300.494 Td /F4 9.8 Tf [(Table 1. Crowd Disasters at Mass Gatherings Reviewed Reports)] TJ ET 0.965 0.965 0.965 rg 26.250 49.863 555.000 240.750 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 290.613 m 581.250 290.613 l 581.250 289.863 l 26.250 289.863 l f q 159.000 0 0 225.000 35.250 55.863 cm /I3 Do Q q 35.250 49.863 537.000 0.000 re W n Q Q q 15.000 49.863 577.500 727.137 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(This review aims to analyse previous cases of disaster at mass gathering events, documenting the lessons identified, to provide )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(considerations when planning for future events. With careful assessment of mass gathering events as a whole it will be possible )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(to plan ahead for the potential number of attendees, consider health and safety aspects of planning for a mass gathering, plan )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(for potential disasters and decrease the risk of the happening, provide a more effective allocation of health resources.)] TJ ET BT 26.250 695.159 Td /F4 12.0 Tf [(Method)] TJ ET BT 26.250 675.205 Td /F1 9.8 Tf [(This literature review concentrates on crowd disasters at mass gathering events, focusing on predominantly on case reports and )] TJ ET BT 26.250 663.300 Td /F1 9.8 Tf [(literature reviews citing particular lessons identified from previous disasters.)] TJ ET BT 26.250 643.896 Td /F1 9.8 Tf [(A literature search was carried out using Medline, Cochrane, HMIC and Embase. A free-text search was also conducted using )] TJ ET BT 26.250 631.991 Td /F1 9.8 Tf [(Google to link mass gathering events to disaster incidents in order to widen the search beyond peer-reviewed publications )] TJ ET BT 26.250 620.086 Td /F1 9.8 Tf [(which included grey literature \(media reports, unpublished reports and commissioned inquiries\). All peer-review literature )] TJ ET BT 26.250 608.181 Td /F1 9.8 Tf [(articles found containing information pertaining to lessons identified from mass gathering crowd disasters were analysed and )] TJ ET BT 26.250 596.277 Td /F1 9.8 Tf [(reviewed. Articles describing disasters occurring in extreme weather events such as heat-related illness, and environmental )] TJ ET BT 26.250 584.372 Td /F1 9.8 Tf [(hazards leading to illness such as disease outbreak were not included. Citations within articles were further searched to identify )] TJ ET BT 26.250 572.467 Td /F1 9.8 Tf [(additional references that would inform this review.)] TJ ET BT 26.250 553.062 Td /F1 9.8 Tf [(Keywords: Mass Gatherings, Mass Gathering Medicine, Disasters, Sporting Events, Olympic Games, Festivals, Concerts, )] TJ ET BT 26.250 541.158 Td /F1 9.8 Tf [(Disaster, Stampede, Fire, Terrorism, Religious Gathering, Air Show.)] TJ ET BT 26.250 504.555 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 484.601 Td /F1 9.8 Tf [(In total, 156 reported mass gathering incidents from 1971 2011, were identified through literature search. While some reports )] TJ ET BT 26.250 472.696 Td /F1 9.8 Tf [(provided valuable information regarding mass gathering disaster occurrence, most cases were descriptive rather than analytical, )] TJ ET BT 26.250 460.791 Td /F1 9.8 Tf [(consequently very few literature reports \(only 21\) were found to inform subjects of lessons identified from disasters at mass )] TJ ET BT 26.250 448.887 Td /F1 9.8 Tf [(gathering events. 17 of these reports had been only reported in journal publications, with four reports having undergone )] TJ ET BT 26.250 436.982 Td /F1 9.8 Tf [(commissioned inquiries.)] TJ ET BT 26.250 417.577 Td /F1 9.8 Tf [(21 reported mass gathering incidents have been read, analysed, abstracted, referenced and complied in chronological order )] TJ ET BT 26.250 405.672 Td /F1 9.8 Tf [(and referenced. Main learning points have been identified and further categorised in to 5 key areas for further discussion:)] TJ ET 0.271 0.267 0.267 RG 40.337 389.235 m 40.337 389.682 40.154 390.126 39.838 390.442 c 39.522 390.758 39.078 390.942 38.631 390.942 c 38.185 390.942 37.741 390.758 37.425 390.442 c 37.109 390.126 36.925 389.682 36.925 389.235 c 36.925 388.789 37.109 388.345 37.425 388.029 c 37.741 387.713 38.185 387.529 38.631 387.529 c 39.078 387.529 39.522 387.713 39.838 388.029 c 40.154 388.345 40.337 388.789 40.337 389.235 c f BT 45.750 386.268 Td /F1 9.8 Tf [(Overcrowding and Crowd Control)] TJ ET 40.337 373.581 m 40.337 374.027 40.154 374.471 39.838 374.787 c 39.522 375.103 39.078 375.287 38.631 375.287 c 38.185 375.287 37.741 375.103 37.425 374.787 c 37.109 374.471 36.925 374.027 36.925 373.581 c 36.925 373.134 37.109 372.690 37.425 372.374 c 37.741 372.058 38.185 371.874 38.631 371.874 c 39.078 371.874 39.522 372.058 39.838 372.374 c 40.154 372.690 40.337 373.134 40.337 373.581 c f BT 45.750 370.613 Td /F1 9.8 Tf [(Event Access Points)] TJ ET 40.337 357.926 m 40.337 358.372 40.154 358.816 39.838 359.132 c 39.522 359.448 39.078 359.632 38.631 359.632 c 38.185 359.632 37.741 359.448 37.425 359.132 c 37.109 358.816 36.925 358.372 36.925 357.926 c 36.925 357.479 37.109 357.035 37.425 356.719 c 37.741 356.403 38.185 356.220 38.631 356.220 c 39.078 356.220 39.522 356.403 39.838 356.719 c 40.154 357.035 40.337 357.479 40.337 357.926 c f BT 45.750 354.958 Td /F1 9.8 Tf [(Fire Safety Measures)] TJ ET 40.337 342.271 m 40.337 342.718 40.154 343.162 39.838 343.478 c 39.522 343.793 39.078 343.977 38.631 343.977 c 38.185 343.977 37.741 343.793 37.425 343.478 c 37.109 343.162 36.925 342.718 36.925 342.271 c 36.925 341.824 37.109 341.380 37.425 341.064 c 37.741 340.749 38.185 340.565 38.631 340.565 c 39.078 340.565 39.522 340.749 39.838 341.064 c 40.154 341.380 40.337 341.824 40.337 342.271 c f BT 45.750 339.303 Td /F1 9.8 Tf [(Medical Preparedness)] TJ ET 40.337 326.616 m 40.337 327.063 40.154 327.507 39.838 327.823 c 39.522 328.139 39.078 328.323 38.631 328.323 c 38.185 328.323 37.741 328.139 37.425 327.823 c 37.109 327.507 36.925 327.063 36.925 326.616 c 36.925 326.170 37.109 325.726 37.425 325.410 c 37.741 325.094 38.185 324.910 38.631 324.910 c 39.078 324.910 39.522 325.094 39.838 325.410 c 40.154 325.726 40.337 326.170 40.337 326.616 c f BT 45.750 323.649 Td /F1 9.8 Tf [(Emergency Response)] TJ ET BT 26.250 300.494 Td /F4 9.8 Tf [(Table 1. Crowd Disasters at Mass Gatherings Reviewed Reports)] TJ ET 0.965 0.965 0.965 rg 26.250 49.863 555.000 240.750 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 290.613 m 581.250 290.613 l 581.250 289.863 l 26.250 289.863 l f q 159.000 0 0 225.000 35.250 55.863 cm /I3 Do Q q 35.250 49.863 537.000 0.000 re W n Q Q q 15.000 49.863 577.500 727.137 re W n 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F1 9.8 Tf [(This review aims to analyse previous cases of disaster at mass gathering events, documenting the lessons identified, to provide )] TJ ET BT 26.250 755.571 Td /F1 9.8 Tf [(considerations when planning for future events. With careful assessment of mass gathering events as a whole it will be possible )] TJ ET BT 26.250 743.667 Td /F1 9.8 Tf [(to plan ahead for the potential number of attendees, consider health and safety aspects of planning for a mass gathering, plan )] TJ ET BT 26.250 731.762 Td /F1 9.8 Tf [(for potential disasters and decrease the risk of the happening, provide a more effective allocation of health resources.)] TJ ET BT 26.250 695.159 Td /F4 12.0 Tf [(Method)] TJ ET BT 26.250 675.205 Td /F1 9.8 Tf [(This literature review concentrates on crowd disasters at mass gathering events, focusing on predominantly on case reports and )] TJ ET BT 26.250 663.300 Td /F1 9.8 Tf [(literature reviews citing particular lessons identified from previous disasters.)] TJ ET BT 26.250 643.896 Td /F1 9.8 Tf [(A literature search was carried out using Medline, Cochrane, HMIC and Embase. A free-text search was also conducted using )] TJ ET BT 26.250 631.991 Td /F1 9.8 Tf [(Google to link mass gathering events to disaster incidents in order to widen the search beyond peer-reviewed publications )] TJ ET BT 26.250 620.086 Td /F1 9.8 Tf [(which included grey literature \(media reports, unpublished reports and commissioned inquiries\). All peer-review literature )] TJ ET BT 26.250 608.181 Td /F1 9.8 Tf [(articles found containing information pertaining to lessons identified from mass gathering crowd disasters were analysed and )] TJ ET BT 26.250 596.277 Td /F1 9.8 Tf [(reviewed. Articles describing disasters occurring in extreme weather events such as heat-related illness, and environmental )] TJ ET BT 26.250 584.372 Td /F1 9.8 Tf [(hazards leading to illness such as disease outbreak were not included. Citations within articles were further searched to identify )] TJ ET BT 26.250 572.467 Td /F1 9.8 Tf [(additional references that would inform this review.)] TJ ET BT 26.250 553.062 Td /F1 9.8 Tf [(Keywords: Mass Gatherings, Mass Gathering Medicine, Disasters, Sporting Events, Olympic Games, Festivals, Concerts, )] TJ ET BT 26.250 541.158 Td /F1 9.8 Tf [(Disaster, Stampede, Fire, Terrorism, Religious Gathering, Air Show.)] TJ ET BT 26.250 504.555 Td /F4 12.0 Tf [(Results)] TJ ET BT 26.250 484.601 Td /F1 9.8 Tf [(In total, 156 reported mass gathering incidents from 1971 2011, were identified through literature search. While some reports )] TJ ET BT 26.250 472.696 Td /F1 9.8 Tf [(provided valuable information regarding mass gathering disaster occurrence, most cases were descriptive rather than analytical, )] TJ ET BT 26.250 460.791 Td /F1 9.8 Tf [(consequently very few literature reports \(only 21\) were found to inform subjects of lessons identified from disasters at mass )] TJ ET BT 26.250 448.887 Td /F1 9.8 Tf [(gathering events. 17 of these reports had been only reported in journal publications, with four reports having undergone )] TJ ET BT 26.250 436.982 Td /F1 9.8 Tf [(commissioned inquiries.)] TJ ET BT 26.250 417.577 Td /F1 9.8 Tf [(21 reported mass gathering incidents have been read, analysed, abstracted, referenced and complied in chronological order )] TJ ET BT 26.250 405.672 Td /F1 9.8 Tf [(and referenced. Main learning points have been identified and further categorised in to 5 key areas for further discussion:)] TJ ET 0.271 0.267 0.267 RG 40.337 389.235 m 40.337 389.682 40.154 390.126 39.838 390.442 c 39.522 390.758 39.078 390.942 38.631 390.942 c 38.185 390.942 37.741 390.758 37.425 390.442 c 37.109 390.126 36.925 389.682 36.925 389.235 c 36.925 388.789 37.109 388.345 37.425 388.029 c 37.741 387.713 38.185 387.529 38.631 387.529 c 39.078 387.529 39.522 387.713 39.838 388.029 c 40.154 388.345 40.337 388.789 40.337 389.235 c f BT 45.750 386.268 Td /F1 9.8 Tf [(Overcrowding and Crowd Control)] TJ ET 40.337 373.581 m 40.337 374.027 40.154 374.471 39.838 374.787 c 39.522 375.103 39.078 375.287 38.631 375.287 c 38.185 375.287 37.741 375.103 37.425 374.787 c 37.109 374.471 36.925 374.027 36.925 373.581 c 36.925 373.134 37.109 372.690 37.425 372.374 c 37.741 372.058 38.185 371.874 38.631 371.874 c 39.078 371.874 39.522 372.058 39.838 372.374 c 40.154 372.690 40.337 373.134 40.337 373.581 c f BT 45.750 370.613 Td /F1 9.8 Tf [(Event Access Points)] TJ ET 40.337 357.926 m 40.337 358.372 40.154 358.816 39.838 359.132 c 39.522 359.448 39.078 359.632 38.631 359.632 c 38.185 359.632 37.741 359.448 37.425 359.132 c 37.109 358.816 36.925 358.372 36.925 357.926 c 36.925 357.479 37.109 357.035 37.425 356.719 c 37.741 356.403 38.185 356.220 38.631 356.220 c 39.078 356.220 39.522 356.403 39.838 356.719 c 40.154 357.035 40.337 357.479 40.337 357.926 c f BT 45.750 354.958 Td /F1 9.8 Tf [(Fire Safety Measures)] TJ ET 40.337 342.271 m 40.337 342.718 40.154 343.162 39.838 343.478 c 39.522 343.793 39.078 343.977 38.631 343.977 c 38.185 343.977 37.741 343.793 37.425 343.478 c 37.109 343.162 36.925 342.718 36.925 342.271 c 36.925 341.824 37.109 341.380 37.425 341.064 c 37.741 340.749 38.185 340.565 38.631 340.565 c 39.078 340.565 39.522 340.749 39.838 341.064 c 40.154 341.380 40.337 341.824 40.337 342.271 c f BT 45.750 339.303 Td /F1 9.8 Tf [(Medical Preparedness)] TJ ET 40.337 326.616 m 40.337 327.063 40.154 327.507 39.838 327.823 c 39.522 328.139 39.078 328.323 38.631 328.323 c 38.185 328.323 37.741 328.139 37.425 327.823 c 37.109 327.507 36.925 327.063 36.925 326.616 c 36.925 326.170 37.109 325.726 37.425 325.410 c 37.741 325.094 38.185 324.910 38.631 324.910 c 39.078 324.910 39.522 325.094 39.838 325.410 c 40.154 325.726 40.337 326.170 40.337 326.616 c f BT 45.750 323.649 Td /F1 9.8 Tf [(Emergency Response)] TJ ET BT 26.250 300.494 Td /F4 9.8 Tf [(Table 1. 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If considered carefully in )] TJ ET BT 26.250 718.419 Td /F1 9.8 Tf [(planning for mass gatherings, these might reduce morbidity and mortality should a disaster occur. These themes include )] TJ ET BT 26.250 706.515 Td /F1 9.8 Tf [(overcrowding and crowd control, event access points and fire safety measures. In addition pertinent issues identified in medical )] TJ ET BT 26.250 694.610 Td /F1 9.8 Tf [(prepraredness and emergency responses are also considered.)] TJ ET BT 26.250 675.205 Td /F4 9.8 Tf [(Overcrowding and Crowd Control)] TJ ET BT 26.250 655.800 Td /F1 9.8 Tf [(Several studies have highlighted that despite venue capacities being completely full, further crowd members still tried to gain )] TJ ET BT 26.250 643.896 Td /F1 9.8 Tf [(access, either due to overselling of tickets or by people turning up just before or after the start of the event. An adequate )] TJ ET BT 26.250 631.991 Td /F1 9.8 Tf [(ticketing system and public address measures to inform crowds of no further access to an event once capacity is reached is )] TJ ET BT 26.250 620.086 Td /F1 9.8 Tf [(essential.)] TJ ET BT 26.250 600.681 Td /F1 9.8 Tf [(Training of stewards and security staff in crowd control should be implemented before an event in an effort to improve crowd )] TJ ET BT 26.250 588.777 Td /F1 9.8 Tf [(safety and avoid panic should overcrowding occur. During a football match in Ellis Park South Africa, tear gas was thrown in to )] TJ ET BT 26.250 576.872 Td /F1 9.8 Tf [(a crowd by event security in an effort to disperse intense overcrowding. This unfortunately served to incite panic and cause )] TJ ET BT 26.250 564.967 Td /F1 9.8 Tf [(stampede )] TJ ET 0.267 0.267 0.267 rg BT 71.773 564.967 Td /F1 9.8 Tf [([5])] TJ ET 0.271 0.267 0.267 rg BT 82.615 564.967 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 545.562 Td /F1 9.8 Tf [(Overcrowding has been linked to the collapse of a temporary stand at a football match in Corsica )] TJ ET 0.267 0.267 0.267 rg BT 446.231 545.562 Td /F1 9.8 Tf [([6])] TJ ET 0.271 0.267 0.267 rg BT 457.073 545.562 Td /F1 9.8 Tf [( , while in the UK, the )] TJ ET BT 26.250 533.658 Td /F1 9.8 Tf [(Hillsborough disaster in April 1989 led to a landmark report by Lord Justice Taylor, to change all football stadia in the UK to all-)] TJ ET BT 26.250 521.753 Td /F1 9.8 Tf [(seater venues, improving crowd safety and control as well as removing pitch-side barriers and improving medical facilities on-)] TJ ET BT 26.250 509.848 Td /F1 9.8 Tf [(site )] TJ ET 0.267 0.267 0.267 rg BT 44.132 509.848 Td /F1 9.8 Tf [([7])] TJ ET 0.271 0.267 0.267 rg BT 54.974 509.848 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 490.443 Td /F1 9.8 Tf [(Two cases at music events have stressed the need to provide mosh pit safety. Since moshing is a dance in which participants )] TJ ET BT 26.250 478.539 Td /F1 9.8 Tf [(push or slam into each other in enclosed spaces, primarily during live music events, mosh pit crowd safety guidelines have been )] TJ ET BT 26.250 466.634 Td /F1 9.8 Tf [(implemented, which include isolating the area from the main audience, provision of nearby first aid, and protocols to stop artists )] TJ ET BT 26.250 454.729 Td /F1 9.8 Tf [(performing should crushing develop )] TJ ET 0.267 0.267 0.267 rg BT 183.400 454.729 Td /F1 9.8 Tf [([8])] TJ ET 0.271 0.267 0.267 rg BT 194.243 454.729 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 435.324 Td /F4 9.8 Tf [(Event Access Points)] TJ ET BT 26.250 415.920 Td /F1 9.8 Tf [(One key structural element to an event venue is the provision of adequate site access, not only for participants but also for )] TJ ET BT 26.250 404.015 Td /F1 9.8 Tf [(emergency medical services.)] TJ ET BT 26.250 384.610 Td /F1 9.8 Tf [(The Ibrox stadium disaster in 1971 )] TJ ET 0.267 0.267 0.267 rg BT 178.525 384.610 Td /F1 9.8 Tf [([9])] TJ ET 0.271 0.267 0.267 rg BT 189.368 384.610 Td /F1 9.8 Tf [( involved fans leaving the stadium getting caught up with fans entering the stadium at the )] TJ ET BT 26.250 372.705 Td /F1 9.8 Tf [(same time, leading to crush and stampede when all fans heard a goal being scored. Further episodes of crowd convergence )] TJ ET BT 26.250 360.801 Td /F1 9.8 Tf [(have occurred at a stampede causing the death of 1,426 during the Hajj in 1990 where pilgrims spontaneously rushed to leave )] TJ ET BT 26.250 348.896 Td /F1 9.8 Tf [(Mecca via one exit )] TJ ET 0.267 0.267 0.267 rg BT 109.700 348.896 Td /F1 9.8 Tf [([10])] TJ ET 0.271 0.267 0.267 rg BT 125.963 348.896 Td /F1 9.8 Tf [( , and during the Love Parade in Germany 2010 where overcrowding led to devastating consequences in )] TJ ET BT 26.250 336.991 Td /F1 9.8 Tf [(a tunnel providing the only means of entrance and exit to fans of a music festival )] TJ ET 0.267 0.267 0.267 rg BT 375.261 336.991 Td /F1 9.8 Tf [([11] [12])] TJ ET 0.271 0.267 0.267 rg BT 410.498 336.991 Td /F1 9.8 Tf [( . To address this, many mass )] TJ ET BT 26.250 325.086 Td /F1 9.8 Tf [(gathering events now have access points solely for entrance or exit at the site, promoting a unidirectional flow of crowd )] TJ ET BT 26.250 313.182 Td /F1 9.8 Tf [(members and dramatically reducing the risk of crowd convergence.)] TJ ET BT 26.250 293.777 Td /F1 9.8 Tf [(Emergency medical services unable to access event sites was found to be a major factor in the prolonged response time to the )] TJ ET BT 26.250 281.872 Td /F1 9.8 Tf [(Ramstein air show disaster, where members of an Italian Air Force display team collided and crashed to the ground )] TJ ET 0.267 0.267 0.267 rg BT 526.406 281.872 Td /F1 9.8 Tf [([13])] TJ ET 0.271 0.267 0.267 rg BT 542.668 281.872 Td /F1 9.8 Tf [( . While )] TJ ET BT 26.250 269.967 Td /F1 9.8 Tf [(at a traditional festival in Cambodia, no access routes were available for emergency medical services to a stampede, severely )] TJ ET BT 26.250 258.063 Td /F1 9.8 Tf [(hindering the medical response )] TJ ET 0.267 0.267 0.267 rg BT 164.437 258.063 Td /F1 9.8 Tf [([14])] TJ ET 0.271 0.267 0.267 rg BT 180.700 258.063 Td /F1 9.8 Tf [( . It is suggested the planning for future events includes provision of easy, unobstructed )] TJ ET BT 26.250 246.158 Td /F1 9.8 Tf [(access for EMS vehicles.)] TJ ET BT 26.250 226.753 Td /F4 9.8 Tf [(Fire Safety Measures)] TJ ET BT 26.250 207.348 Td /F1 9.8 Tf [(Fire safety has become an increasing part of emergency planning, however several lessons can still be identified. The stardust )] TJ ET BT 26.250 195.444 Td /F1 9.8 Tf [(fire in Dublin 1981 was thought to have been deliberately started from the ignition of newspapers under flammable seats )] TJ ET BT 26.250 183.539 Td /F1 9.8 Tf [(resulting in 48 deaths and 128 injuries )] TJ ET 0.267 0.267 0.267 rg BT 193.170 183.539 Td /F1 9.8 Tf [([15])] TJ ET 0.271 0.267 0.267 rg BT 209.433 183.539 Td /F1 9.8 Tf [( .The Bradford City Stadium Disaster is thought to have started by a dropped match )] TJ ET BT 26.250 171.634 Td /F1 9.8 Tf [(or cigarette falling through floorboards to rubbish below )] TJ ET 0.267 0.267 0.267 rg BT 266.861 171.634 Td /F1 9.8 Tf [([16])] TJ ET 0.271 0.267 0.267 rg BT 283.123 171.634 Td /F1 9.8 Tf [( . 441 deaths occurred at an Indian wedding due to a synthetic cloth )] TJ ET BT 26.250 159.729 Td /F1 9.8 Tf [(tent catching fire in a large area with no means of emergency exit )] TJ ET 0.267 0.267 0.267 rg BT 310.755 159.729 Td /F1 9.8 Tf [([17] )] TJ ET 0.271 0.267 0.267 rg BT 329.728 159.729 Td /F1 9.8 Tf [(, and 375 attendees were caught in a nightclub fire in )] TJ ET BT 26.250 147.825 Td /F1 9.8 Tf [(Gothenburg, Sweden when the venue was only supposed to hold 150 with the fire starting in front of the emergency exit )] TJ ET 0.267 0.267 0.267 rg BT 544.901 147.825 Td /F1 9.8 Tf [([18])] TJ ET 0.271 0.267 0.267 rg BT 561.164 147.825 Td /F1 9.8 Tf [( . )] TJ ET BT 26.250 135.920 Td /F1 9.8 Tf [(Only one of three emergency exits were available during a nightclub fire in Volendam, Netherlands )] TJ ET 0.267 0.267 0.267 rg BT 453.271 135.920 Td /F1 9.8 Tf [([19])] TJ ET 0.271 0.267 0.267 rg BT 469.534 135.920 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 116.515 Td /F1 9.8 Tf [(From the five events reviewed it appears that all fire disasters had similar attributes that emergency planners should consider )] TJ ET BT 26.250 104.610 Td /F1 9.8 Tf [(when planning for a mass gathering:)] TJ ET 0.271 0.267 0.267 RG 40.337 88.173 m 40.337 88.620 40.154 89.064 39.838 89.380 c 39.522 89.696 39.078 89.879 38.631 89.879 c 38.185 89.879 37.741 89.696 37.425 89.380 c 37.109 89.064 36.925 88.620 36.925 88.173 c 36.925 87.727 37.109 87.283 37.425 86.967 c 37.741 86.651 38.185 86.467 38.631 86.467 c 39.078 86.467 39.522 86.651 39.838 86.967 c 40.154 87.283 40.337 87.727 40.337 88.173 c f BT 45.750 85.206 Td /F1 9.8 Tf [(Several emergency exits should be made available at any planned event.)] TJ ET 40.337 72.518 m 40.337 72.965 40.154 73.409 39.838 73.725 c 39.522 74.041 39.078 74.225 38.631 74.225 c 38.185 74.225 37.741 74.041 37.425 73.725 c 37.109 73.409 36.925 72.965 36.925 72.518 c 36.925 72.072 37.109 71.628 37.425 71.312 c 37.741 70.996 38.185 70.812 38.631 70.812 c 39.078 70.812 39.522 70.996 39.838 71.312 c 40.154 71.628 40.337 72.072 40.337 72.518 c f BT 45.750 69.551 Td /F1 9.8 Tf [(Emergency exits should be free from obstruction, not blocked and functioning properly, with appropriate signage.)] TJ ET 40.337 56.864 m 40.337 57.310 40.154 57.754 39.838 58.070 c 39.522 58.386 39.078 58.570 38.631 58.570 c 38.185 58.570 37.741 58.386 37.425 58.070 c 37.109 57.754 36.925 57.310 36.925 56.864 c 36.925 56.417 37.109 55.973 37.425 55.657 c 37.741 55.341 38.185 55.157 38.631 55.157 c 39.078 55.157 39.522 55.341 39.838 55.657 c 40.154 55.973 40.337 56.417 40.337 56.864 c f BT 45.750 53.896 Td /F1 9.8 Tf [(Adherence to fire safety protocols is key including prevention of overcrowding of venues.)] TJ ET Q q 15.000 47.765 577.500 729.235 re W n 0.965 0.965 0.965 rg 26.250 777.000 555.000 0.000 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 777.000 m 581.250 777.000 l 581.250 777.750 l 26.250 777.750 l f q 35.250 777.000 537.000 0.000 re W n Q 0.271 0.267 0.267 rg BT 26.250 750.278 Td /F4 12.0 Tf [(Discussion)] TJ ET BT 26.250 730.324 Td /F1 9.8 Tf [(Generic themes from disasters at mass gathering events emerge from this collection of literature. If considered carefully in )] TJ ET BT 26.250 718.419 Td /F1 9.8 Tf [(planning for mass gatherings, these might reduce morbidity and mortality should a disaster occur. These themes include )] TJ ET BT 26.250 706.515 Td /F1 9.8 Tf [(overcrowding and crowd control, event access points and fire safety measures. In addition pertinent issues identified in medical )] TJ ET BT 26.250 694.610 Td /F1 9.8 Tf [(prepraredness and emergency responses are also considered.)] TJ ET BT 26.250 675.205 Td /F4 9.8 Tf [(Overcrowding and Crowd Control)] TJ ET BT 26.250 655.800 Td /F1 9.8 Tf [(Several studies have highlighted that despite venue capacities being completely full, further crowd members still tried to gain )] TJ ET BT 26.250 643.896 Td /F1 9.8 Tf [(access, either due to overselling of tickets or by people turning up just before or after the start of the event. An adequate )] TJ ET BT 26.250 631.991 Td /F1 9.8 Tf [(ticketing system and public address measures to inform crowds of no further access to an event once capacity is reached is )] TJ ET BT 26.250 620.086 Td /F1 9.8 Tf [(essential.)] TJ ET BT 26.250 600.681 Td /F1 9.8 Tf [(Training of stewards and security staff in crowd control should be implemented before an event in an effort to improve crowd )] TJ ET BT 26.250 588.777 Td /F1 9.8 Tf [(safety and avoid panic should overcrowding occur. During a football match in Ellis Park South Africa, tear gas was thrown in to )] TJ ET BT 26.250 576.872 Td /F1 9.8 Tf [(a crowd by event security in an effort to disperse intense overcrowding. This unfortunately served to incite panic and cause )] TJ ET BT 26.250 564.967 Td /F1 9.8 Tf [(stampede )] TJ ET 0.267 0.267 0.267 rg BT 71.773 564.967 Td /F1 9.8 Tf [([5])] TJ ET 0.271 0.267 0.267 rg BT 82.615 564.967 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 545.562 Td /F1 9.8 Tf [(Overcrowding has been linked to the collapse of a temporary stand at a football match in Corsica )] TJ ET 0.267 0.267 0.267 rg BT 446.231 545.562 Td /F1 9.8 Tf [([6])] TJ ET 0.271 0.267 0.267 rg BT 457.073 545.562 Td /F1 9.8 Tf [( , while in the UK, the )] TJ ET BT 26.250 533.658 Td /F1 9.8 Tf [(Hillsborough disaster in April 1989 led to a landmark report by Lord Justice Taylor, to change all football stadia in the UK to all-)] TJ ET BT 26.250 521.753 Td /F1 9.8 Tf [(seater venues, improving crowd safety and control as well as removing pitch-side barriers and improving medical facilities on-)] TJ ET BT 26.250 509.848 Td /F1 9.8 Tf [(site )] TJ ET 0.267 0.267 0.267 rg BT 44.132 509.848 Td /F1 9.8 Tf [([7])] TJ ET 0.271 0.267 0.267 rg BT 54.974 509.848 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 490.443 Td /F1 9.8 Tf [(Two cases at music events have stressed the need to provide mosh pit safety. Since moshing is a dance in which participants )] TJ ET BT 26.250 478.539 Td /F1 9.8 Tf [(push or slam into each other in enclosed spaces, primarily during live music events, mosh pit crowd safety guidelines have been )] TJ ET BT 26.250 466.634 Td /F1 9.8 Tf [(implemented, which include isolating the area from the main audience, provision of nearby first aid, and protocols to stop artists )] TJ ET BT 26.250 454.729 Td /F1 9.8 Tf [(performing should crushing develop )] TJ ET 0.267 0.267 0.267 rg BT 183.400 454.729 Td /F1 9.8 Tf [([8])] TJ ET 0.271 0.267 0.267 rg BT 194.243 454.729 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 435.324 Td /F4 9.8 Tf [(Event Access Points)] TJ ET BT 26.250 415.920 Td /F1 9.8 Tf [(One key structural element to an event venue is the provision of adequate site access, not only for participants but also for )] TJ ET BT 26.250 404.015 Td /F1 9.8 Tf [(emergency medical services.)] TJ ET BT 26.250 384.610 Td /F1 9.8 Tf [(The Ibrox stadium disaster in 1971 )] TJ ET 0.267 0.267 0.267 rg BT 178.525 384.610 Td /F1 9.8 Tf [([9])] TJ ET 0.271 0.267 0.267 rg BT 189.368 384.610 Td /F1 9.8 Tf [( involved fans leaving the stadium getting caught up with fans entering the stadium at the )] TJ ET BT 26.250 372.705 Td /F1 9.8 Tf [(same time, leading to crush and stampede when all fans heard a goal being scored. Further episodes of crowd convergence )] TJ ET BT 26.250 360.801 Td /F1 9.8 Tf [(have occurred at a stampede causing the death of 1,426 during the Hajj in 1990 where pilgrims spontaneously rushed to leave )] TJ ET BT 26.250 348.896 Td /F1 9.8 Tf [(Mecca via one exit )] TJ ET 0.267 0.267 0.267 rg BT 109.700 348.896 Td /F1 9.8 Tf [([10])] TJ ET 0.271 0.267 0.267 rg BT 125.963 348.896 Td /F1 9.8 Tf [( , and during the Love Parade in Germany 2010 where overcrowding led to devastating consequences in )] TJ ET BT 26.250 336.991 Td /F1 9.8 Tf [(a tunnel providing the only means of entrance and exit to fans of a music festival )] TJ ET 0.267 0.267 0.267 rg BT 375.261 336.991 Td /F1 9.8 Tf [([11] [12])] TJ ET 0.271 0.267 0.267 rg BT 410.498 336.991 Td /F1 9.8 Tf [( . To address this, many mass )] TJ ET BT 26.250 325.086 Td /F1 9.8 Tf [(gathering events now have access points solely for entrance or exit at the site, promoting a unidirectional flow of crowd )] TJ ET BT 26.250 313.182 Td /F1 9.8 Tf [(members and dramatically reducing the risk of crowd convergence.)] TJ ET BT 26.250 293.777 Td /F1 9.8 Tf [(Emergency medical services unable to access event sites was found to be a major factor in the prolonged response time to the )] TJ ET BT 26.250 281.872 Td /F1 9.8 Tf [(Ramstein air show disaster, where members of an Italian Air Force display team collided and crashed to the ground )] TJ ET 0.267 0.267 0.267 rg BT 526.406 281.872 Td /F1 9.8 Tf [([13])] TJ ET 0.271 0.267 0.267 rg BT 542.668 281.872 Td /F1 9.8 Tf [( . While )] TJ ET BT 26.250 269.967 Td /F1 9.8 Tf [(at a traditional festival in Cambodia, no access routes were available for emergency medical services to a stampede, severely )] TJ ET BT 26.250 258.063 Td /F1 9.8 Tf [(hindering the medical response )] TJ ET 0.267 0.267 0.267 rg BT 164.437 258.063 Td /F1 9.8 Tf [([14])] TJ ET 0.271 0.267 0.267 rg BT 180.700 258.063 Td /F1 9.8 Tf [( . It is suggested the planning for future events includes provision of easy, unobstructed )] TJ ET BT 26.250 246.158 Td /F1 9.8 Tf [(access for EMS vehicles.)] TJ ET BT 26.250 226.753 Td /F4 9.8 Tf [(Fire Safety Measures)] TJ ET BT 26.250 207.348 Td /F1 9.8 Tf [(Fire safety has become an increasing part of emergency planning, however several lessons can still be identified. The stardust )] TJ ET BT 26.250 195.444 Td /F1 9.8 Tf [(fire in Dublin 1981 was thought to have been deliberately started from the ignition of newspapers under flammable seats )] TJ ET BT 26.250 183.539 Td /F1 9.8 Tf [(resulting in 48 deaths and 128 injuries )] TJ ET 0.267 0.267 0.267 rg BT 193.170 183.539 Td /F1 9.8 Tf [([15])] TJ ET 0.271 0.267 0.267 rg BT 209.433 183.539 Td /F1 9.8 Tf [( .The Bradford City Stadium Disaster is thought to have started by a dropped match )] TJ ET BT 26.250 171.634 Td /F1 9.8 Tf [(or cigarette falling through floorboards to rubbish below )] TJ ET 0.267 0.267 0.267 rg BT 266.861 171.634 Td /F1 9.8 Tf [([16])] TJ ET 0.271 0.267 0.267 rg BT 283.123 171.634 Td /F1 9.8 Tf [( . 441 deaths occurred at an Indian wedding due to a synthetic cloth )] TJ ET BT 26.250 159.729 Td /F1 9.8 Tf [(tent catching fire in a large area with no means of emergency exit )] TJ ET 0.267 0.267 0.267 rg BT 310.755 159.729 Td /F1 9.8 Tf [([17] )] TJ ET 0.271 0.267 0.267 rg BT 329.728 159.729 Td /F1 9.8 Tf [(, and 375 attendees were caught in a nightclub fire in )] TJ ET BT 26.250 147.825 Td /F1 9.8 Tf [(Gothenburg, Sweden when the venue was only supposed to hold 150 with the fire starting in front of the emergency exit )] TJ ET 0.267 0.267 0.267 rg BT 544.901 147.825 Td /F1 9.8 Tf [([18])] TJ ET 0.271 0.267 0.267 rg BT 561.164 147.825 Td /F1 9.8 Tf [( . )] TJ ET BT 26.250 135.920 Td /F1 9.8 Tf [(Only one of three emergency exits were available during a nightclub fire in Volendam, Netherlands )] TJ ET 0.267 0.267 0.267 rg BT 453.271 135.920 Td /F1 9.8 Tf [([19])] TJ ET 0.271 0.267 0.267 rg BT 469.534 135.920 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 116.515 Td /F1 9.8 Tf [(From the five events reviewed it appears that all fire disasters had similar attributes that emergency planners should consider )] TJ ET BT 26.250 104.610 Td /F1 9.8 Tf [(when planning for a mass gathering:)] TJ ET 0.271 0.267 0.267 RG 40.337 88.173 m 40.337 88.620 40.154 89.064 39.838 89.380 c 39.522 89.696 39.078 89.879 38.631 89.879 c 38.185 89.879 37.741 89.696 37.425 89.380 c 37.109 89.064 36.925 88.620 36.925 88.173 c 36.925 87.727 37.109 87.283 37.425 86.967 c 37.741 86.651 38.185 86.467 38.631 86.467 c 39.078 86.467 39.522 86.651 39.838 86.967 c 40.154 87.283 40.337 87.727 40.337 88.173 c f BT 45.750 85.206 Td /F1 9.8 Tf [(Several emergency exits should be made available at any planned event.)] TJ ET 40.337 72.518 m 40.337 72.965 40.154 73.409 39.838 73.725 c 39.522 74.041 39.078 74.225 38.631 74.225 c 38.185 74.225 37.741 74.041 37.425 73.725 c 37.109 73.409 36.925 72.965 36.925 72.518 c 36.925 72.072 37.109 71.628 37.425 71.312 c 37.741 70.996 38.185 70.812 38.631 70.812 c 39.078 70.812 39.522 70.996 39.838 71.312 c 40.154 71.628 40.337 72.072 40.337 72.518 c f BT 45.750 69.551 Td /F1 9.8 Tf [(Emergency exits should be free from obstruction, not blocked and functioning properly, with appropriate signage.)] TJ ET 40.337 56.864 m 40.337 57.310 40.154 57.754 39.838 58.070 c 39.522 58.386 39.078 58.570 38.631 58.570 c 38.185 58.570 37.741 58.386 37.425 58.070 c 37.109 57.754 36.925 57.310 36.925 56.864 c 36.925 56.417 37.109 55.973 37.425 55.657 c 37.741 55.341 38.185 55.157 38.631 55.157 c 39.078 55.157 39.522 55.341 39.838 55.657 c 40.154 55.973 40.337 56.417 40.337 56.864 c f BT 45.750 53.896 Td /F1 9.8 Tf [(Adherence to fire safety protocols is key including prevention of overcrowding of venues.)] TJ ET Q q 15.000 47.765 577.500 729.235 re W n 0.965 0.965 0.965 rg 26.250 777.000 555.000 0.000 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 777.000 m 581.250 777.000 l 581.250 777.750 l 26.250 777.750 l f q 35.250 777.000 537.000 0.000 re W n Q 0.271 0.267 0.267 rg BT 26.250 750.278 Td /F4 12.0 Tf [(Discussion)] TJ ET BT 26.250 730.324 Td /F1 9.8 Tf [(Generic themes from disasters at mass gathering events emerge from this collection of literature. If considered carefully in )] TJ ET BT 26.250 718.419 Td /F1 9.8 Tf [(planning for mass gatherings, these might reduce morbidity and mortality should a disaster occur. These themes include )] TJ ET BT 26.250 706.515 Td /F1 9.8 Tf [(overcrowding and crowd control, event access points and fire safety measures. In addition pertinent issues identified in medical )] TJ ET BT 26.250 694.610 Td /F1 9.8 Tf [(prepraredness and emergency responses are also considered.)] TJ ET BT 26.250 675.205 Td /F4 9.8 Tf [(Overcrowding and Crowd Control)] TJ ET BT 26.250 655.800 Td /F1 9.8 Tf [(Several studies have highlighted that despite venue capacities being completely full, further crowd members still tried to gain )] TJ ET BT 26.250 643.896 Td /F1 9.8 Tf [(access, either due to overselling of tickets or by people turning up just before or after the start of the event. An adequate )] TJ ET BT 26.250 631.991 Td /F1 9.8 Tf [(ticketing system and public address measures to inform crowds of no further access to an event once capacity is reached is )] TJ ET BT 26.250 620.086 Td /F1 9.8 Tf [(essential.)] TJ ET BT 26.250 600.681 Td /F1 9.8 Tf [(Training of stewards and security staff in crowd control should be implemented before an event in an effort to improve crowd )] TJ ET BT 26.250 588.777 Td /F1 9.8 Tf [(safety and avoid panic should overcrowding occur. During a football match in Ellis Park South Africa, tear gas was thrown in to )] TJ ET BT 26.250 576.872 Td /F1 9.8 Tf [(a crowd by event security in an effort to disperse intense overcrowding. This unfortunately served to incite panic and cause )] TJ ET BT 26.250 564.967 Td /F1 9.8 Tf [(stampede )] TJ ET 0.267 0.267 0.267 rg BT 71.773 564.967 Td /F1 9.8 Tf [([5])] TJ ET 0.271 0.267 0.267 rg BT 82.615 564.967 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 545.562 Td /F1 9.8 Tf [(Overcrowding has been linked to the collapse of a temporary stand at a football match in Corsica )] TJ ET 0.267 0.267 0.267 rg BT 446.231 545.562 Td /F1 9.8 Tf [([6])] TJ ET 0.271 0.267 0.267 rg BT 457.073 545.562 Td /F1 9.8 Tf [( , while in the UK, the )] TJ ET BT 26.250 533.658 Td /F1 9.8 Tf [(Hillsborough disaster in April 1989 led to a landmark report by Lord Justice Taylor, to change all football stadia in the UK to all-)] TJ ET BT 26.250 521.753 Td /F1 9.8 Tf [(seater venues, improving crowd safety and control as well as removing pitch-side barriers and improving medical facilities on-)] TJ ET BT 26.250 509.848 Td /F1 9.8 Tf [(site )] TJ ET 0.267 0.267 0.267 rg BT 44.132 509.848 Td /F1 9.8 Tf [([7])] TJ ET 0.271 0.267 0.267 rg BT 54.974 509.848 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 490.443 Td /F1 9.8 Tf [(Two cases at music events have stressed the need to provide mosh pit safety. 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To address this, many mass )] TJ ET BT 26.250 325.086 Td /F1 9.8 Tf [(gathering events now have access points solely for entrance or exit at the site, promoting a unidirectional flow of crowd )] TJ ET BT 26.250 313.182 Td /F1 9.8 Tf [(members and dramatically reducing the risk of crowd convergence.)] TJ ET BT 26.250 293.777 Td /F1 9.8 Tf [(Emergency medical services unable to access event sites was found to be a major factor in the prolonged response time to the )] TJ ET BT 26.250 281.872 Td /F1 9.8 Tf [(Ramstein air show disaster, where members of an Italian Air Force display team collided and crashed to the ground )] TJ ET 0.267 0.267 0.267 rg BT 526.406 281.872 Td /F1 9.8 Tf [([13])] TJ ET 0.271 0.267 0.267 rg BT 542.668 281.872 Td /F1 9.8 Tf [( . While )] TJ ET BT 26.250 269.967 Td /F1 9.8 Tf [(at a traditional festival in Cambodia, no access routes were available for emergency medical services to a stampede, severely )] TJ ET BT 26.250 258.063 Td /F1 9.8 Tf [(hindering the medical response )] TJ ET 0.267 0.267 0.267 rg BT 164.437 258.063 Td /F1 9.8 Tf [([14])] TJ ET 0.271 0.267 0.267 rg BT 180.700 258.063 Td /F1 9.8 Tf [( . It is suggested the planning for future events includes provision of easy, unobstructed )] TJ ET BT 26.250 246.158 Td /F1 9.8 Tf [(access for EMS vehicles.)] TJ ET BT 26.250 226.753 Td /F4 9.8 Tf [(Fire Safety Measures)] TJ ET BT 26.250 207.348 Td /F1 9.8 Tf [(Fire safety has become an increasing part of emergency planning, however several lessons can still be identified. 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159.729 Td /F1 9.8 Tf [(, and 375 attendees were caught in a nightclub fire in )] TJ ET BT 26.250 147.825 Td /F1 9.8 Tf [(Gothenburg, Sweden when the venue was only supposed to hold 150 with the fire starting in front of the emergency exit )] TJ ET 0.267 0.267 0.267 rg BT 544.901 147.825 Td /F1 9.8 Tf [([18])] TJ ET 0.271 0.267 0.267 rg BT 561.164 147.825 Td /F1 9.8 Tf [( . )] TJ ET BT 26.250 135.920 Td /F1 9.8 Tf [(Only one of three emergency exits were available during a nightclub fire in Volendam, Netherlands )] TJ ET 0.267 0.267 0.267 rg BT 453.271 135.920 Td /F1 9.8 Tf [([19])] TJ ET 0.271 0.267 0.267 rg BT 469.534 135.920 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 116.515 Td /F1 9.8 Tf [(From the five events reviewed it appears that all fire disasters had similar attributes that emergency planners should consider )] TJ ET BT 26.250 104.610 Td /F1 9.8 Tf [(when planning for a mass gathering:)] TJ ET 0.271 0.267 0.267 RG 40.337 88.173 m 40.337 88.620 40.154 89.064 39.838 89.380 c 39.522 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The majority of )] TJ ET BT 26.250 673.548 Td /F1 9.8 Tf [(non-disaster injuries and medical complaints at a mass gathering can be effectively treated on scene, which reduces the )] TJ ET BT 26.250 661.643 Td /F1 9.8 Tf [(number of hospital referrals and patient presentation rates to hospital )] TJ ET 0.267 0.267 0.267 rg BT 326.482 661.643 Td /F1 9.8 Tf [([21])] TJ ET 0.271 0.267 0.267 rg BT 342.745 661.643 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 642.238 Td /F1 9.8 Tf [(Following the Hillsborough Stadium disaster 1989, Lord Justice Taylor )] TJ ET 0.267 0.267 0.267 rg BT 330.781 642.238 Td /F1 9.8 Tf [([22])] TJ ET 0.271 0.267 0.267 rg BT 347.044 642.238 Td /F1 9.8 Tf [( made suggestions to improve on-site medical care )] TJ ET BT 26.250 630.333 Td /F1 9.8 Tf [(\(Box 1\):)] TJ ET 0.965 0.965 0.965 rg 26.250 530.452 555.000 90.000 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 620.452 m 581.250 620.452 l 581.250 619.702 l 26.250 619.702 l f 26.250 530.452 m 581.250 530.452 l 581.250 531.202 l 26.250 531.202 l f q 225.000 0 0 70.500 35.250 540.202 cm /I4 Do Q q 35.250 534.202 537.000 0.000 re W n Q 0.271 0.267 0.267 rg BT 26.250 513.429 Td /F1 9.8 Tf [(On-site medical care has also dramatically improved following several stampedes occurring during the annual Islamic )] TJ ET BT 26.250 501.524 Td /F1 9.8 Tf [(pilgrimage of the Hajj [)] TJ ET 0.267 0.267 0.267 rg BT 123.243 501.524 Td /F1 9.8 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 134.085 501.524 Td /F1 9.8 Tf [(] . The most notable event in 2006 resulted in 346 deaths at a bottleneck area in the Mina Valley. The )] TJ ET BT 26.250 489.619 Td /F1 9.8 Tf [(provision of specially equipped medical care facilities, helipads, electronic surveillance, shading and cooling mists have helped )] TJ ET BT 26.250 477.714 Td /F1 9.8 Tf [(to reduce crowd morbidity and mortality [)] TJ ET 0.267 0.267 0.267 rg BT 201.809 477.714 Td /F1 9.8 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 212.651 477.714 Td /F1 9.8 Tf [(] . Local hospitals should also be involved with emergency planning in preparation )] TJ ET BT 26.250 465.810 Td /F1 9.8 Tf [(for potential mass gathering disasters. Madzimabuto [)] TJ ET 0.267 0.267 0.267 rg BT 257.637 465.810 Td /F1 9.8 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 268.479 465.810 Td /F1 9.8 Tf [(] , in a review of a stampede at a football match identified the following )] TJ ET BT 26.250 453.905 Td /F1 9.8 Tf [(hospital preparedness deficiencies identified as:)] TJ ET 0.271 0.267 0.267 RG 40.337 437.468 m 40.337 437.914 40.154 438.358 39.838 438.674 c 39.522 438.990 39.078 439.174 38.631 439.174 c 38.185 439.174 37.741 438.990 37.425 438.674 c 37.109 438.358 36.925 437.914 36.925 437.468 c 36.925 437.021 37.109 436.577 37.425 436.261 c 37.741 435.945 38.185 435.762 38.631 435.762 c 39.078 435.762 39.522 435.945 39.838 436.261 c 40.154 436.577 40.337 437.021 40.337 437.468 c f BT 45.750 434.500 Td /F1 9.8 Tf [(Emergency department only first aware when injured arrived)] TJ ET 40.337 421.813 m 40.337 422.260 40.154 422.704 39.838 423.020 c 39.522 423.335 39.078 423.519 38.631 423.519 c 38.185 423.519 37.741 423.335 37.425 423.020 c 37.109 422.704 36.925 422.260 36.925 421.813 c 36.925 421.366 37.109 420.922 37.425 420.606 c 37.741 420.291 38.185 420.107 38.631 420.107 c 39.078 420.107 39.522 420.291 39.838 420.606 c 40.154 420.922 40.337 421.366 40.337 421.813 c f BT 45.750 418.845 Td /F1 9.8 Tf [(No major incident plan was prepared which led to the emergency department being overwhelmed)] TJ ET 40.337 406.158 m 40.337 406.605 40.154 407.049 39.838 407.365 c 39.522 407.681 39.078 407.865 38.631 407.865 c 38.185 407.865 37.741 407.681 37.425 407.365 c 37.109 407.049 36.925 406.605 36.925 406.158 c 36.925 405.712 37.109 405.268 37.425 404.952 c 37.741 404.636 38.185 404.452 38.631 404.452 c 39.078 404.452 39.522 404.636 39.838 404.952 c 40.154 405.268 40.337 405.712 40.337 406.158 c f BT 45.750 403.191 Td /F1 9.8 Tf [(A hospital command centre was not set up)] TJ ET 40.337 390.504 m 40.337 390.950 40.154 391.394 39.838 391.710 c 39.522 392.026 39.078 392.210 38.631 392.210 c 38.185 392.210 37.741 392.026 37.425 391.710 c 37.109 391.394 36.925 390.950 36.925 390.504 c 36.925 390.057 37.109 389.613 37.425 389.297 c 37.741 388.981 38.185 388.797 38.631 388.797 c 39.078 388.797 39.522 388.981 39.838 389.297 c 40.154 389.613 40.337 390.057 40.337 390.504 c f BT 45.750 387.536 Td /F1 9.8 Tf [(Staff reinforcements were unable to be contacted)] TJ ET 40.337 374.849 m 40.337 375.295 40.154 375.739 39.838 376.055 c 39.522 376.371 39.078 376.555 38.631 376.555 c 38.185 376.555 37.741 376.371 37.425 376.055 c 37.109 375.739 36.925 375.295 36.925 374.849 c 36.925 374.402 37.109 373.958 37.425 373.642 c 37.741 373.326 38.185 373.143 38.631 373.143 c 39.078 373.143 39.522 373.326 39.838 373.642 c 40.154 373.958 40.337 374.402 40.337 374.849 c f BT 45.750 371.881 Td /F1 9.8 Tf [(Medical teams were not organised to prioritise mass casualty care)] TJ ET 40.337 359.194 m 40.337 359.641 40.154 360.085 39.838 360.401 c 39.522 360.716 39.078 360.900 38.631 360.900 c 38.185 360.900 37.741 360.716 37.425 360.401 c 37.109 360.085 36.925 359.641 36.925 359.194 c 36.925 358.747 37.109 358.303 37.425 357.987 c 37.741 357.672 38.185 357.488 38.631 357.488 c 39.078 357.488 39.522 357.672 39.838 357.987 c 40.154 358.303 40.337 358.747 40.337 359.194 c f BT 45.750 356.226 Td /F1 9.8 Tf [(The media arrived, distracting emergency department personnel)] TJ ET 40.337 343.539 m 40.337 343.986 40.154 344.430 39.838 344.746 c 39.522 345.062 39.078 345.246 38.631 345.246 c 38.185 345.246 37.741 345.062 37.425 344.746 c 37.109 344.430 36.925 343.986 36.925 343.539 c 36.925 343.093 37.109 342.649 37.425 342.333 c 37.741 342.017 38.185 341.833 38.631 341.833 c 39.078 341.833 39.522 342.017 39.838 342.333 c 40.154 342.649 40.337 343.093 40.337 343.539 c f BT 45.750 340.572 Td /F1 9.8 Tf [(Supporting hospitals were not involved in a timely manner)] TJ ET BT 26.250 317.417 Td /F1 9.8 Tf [(It is suggested that when planning for a mass gathering event, local hospitals should be involved in healthcare provision not )] TJ ET BT 26.250 305.512 Td /F1 9.8 Tf [(only on-site but also for their own planning of mass casualty events allowing for potential occurrence of disaster.)] TJ ET BT 26.250 286.107 Td /F1 9.8 Tf [(For mass gatherings on larger scale such as Olympic Games, an assessment of terrorism risk assessment might be necessary, )] TJ ET BT 26.250 274.203 Td /F1 9.8 Tf [(with further medical provisions available during these planned events. For example Feliciano et al )] TJ ET 0.267 0.267 0.267 rg BT 448.922 274.203 Td /F1 9.8 Tf [([24])] TJ ET 0.271 0.267 0.267 rg BT 465.185 274.203 Td /F1 9.8 Tf [( reported that there was )] TJ ET BT 26.250 262.298 Td /F1 9.8 Tf [(extensive pre-Olympics preparation \(Box\) at the regional Level 1 trauma centre before the Atlanta Games in 1996. In particular )] TJ ET BT 26.250 250.393 Td /F1 9.8 Tf [(the pre-hospital training \(point 4, box 2\) resulted in an excellent hospital-wide response to the multi-casualty event following the )] TJ ET BT 26.250 238.488 Td /F1 9.8 Tf [(explosion of a pipe-bomb in Centennial Park during these 1996 Olympics which resulted in 1 death and 21 injured on scene.)] TJ ET 0.965 0.965 0.965 rg 26.250 30.608 555.000 198.000 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 228.608 m 581.250 228.608 l 581.250 227.858 l 26.250 227.858 l f q 225.000 0 0 182.250 35.250 36.608 cm /I5 Do Q q 35.250 30.608 537.000 0.000 re W n Q Q q 15.000 30.608 577.500 746.392 re W n 0.271 0.267 0.267 rg 0.271 0.267 0.267 RG 40.337 770.444 m 40.337 770.890 40.154 771.334 39.838 771.650 c 39.522 771.966 39.078 772.150 38.631 772.150 c 38.185 772.150 37.741 771.966 37.425 771.650 c 37.109 771.334 36.925 770.890 36.925 770.444 c 36.925 769.997 37.109 769.553 37.425 769.237 c 37.741 768.921 38.185 768.738 38.631 768.738 c 39.078 768.738 39.522 768.921 39.838 769.237 c 40.154 769.553 40.337 769.997 40.337 770.444 c f BT 45.750 767.476 Td /F1 9.8 Tf [(Event employees should be allotted specific duties to be performed in the event of the fire, with regular fire drills held on the )] TJ ET BT 45.750 755.571 Td /F1 9.8 Tf [(premises.)] TJ ET 40.337 742.884 m 40.337 743.331 40.154 743.775 39.838 744.091 c 39.522 744.407 39.078 744.590 38.631 744.590 c 38.185 744.590 37.741 744.407 37.425 744.091 c 37.109 743.775 36.925 743.331 36.925 742.884 c 36.925 742.438 37.109 741.994 37.425 741.678 c 37.741 741.362 38.185 741.178 38.631 741.178 c 39.078 741.178 39.522 741.362 39.838 741.678 c 40.154 741.994 40.337 742.438 40.337 742.884 c f BT 45.750 739.917 Td /F1 9.8 Tf [(Full site fire evacuation plans are essential. These could include signage to evacuation points.)] TJ ET BT 26.250 716.762 Td /F4 9.8 Tf [(Medical Preparedness)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(Provision of on-site physician-level medical care at mass gatherings has been shown to significantly reduce the number of )] TJ ET BT 26.250 685.452 Td /F1 9.8 Tf [(patients requiring transport to hospital and therefore reducing the impact on the local ambulance services )] TJ ET 0.267 0.267 0.267 rg BT 482.004 685.452 Td /F1 9.8 Tf [([20])] TJ ET 0.271 0.267 0.267 rg BT 498.267 685.452 Td /F1 9.8 Tf [( . The majority of )] TJ ET BT 26.250 673.548 Td /F1 9.8 Tf [(non-disaster injuries and medical complaints at a mass gathering can be effectively treated on scene, which reduces the )] TJ ET BT 26.250 661.643 Td /F1 9.8 Tf [(number of hospital referrals and patient presentation rates to hospital )] TJ ET 0.267 0.267 0.267 rg BT 326.482 661.643 Td /F1 9.8 Tf [([21])] TJ ET 0.271 0.267 0.267 rg BT 342.745 661.643 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 642.238 Td /F1 9.8 Tf [(Following the Hillsborough Stadium disaster 1989, Lord Justice Taylor )] TJ ET 0.267 0.267 0.267 rg BT 330.781 642.238 Td /F1 9.8 Tf [([22])] TJ ET 0.271 0.267 0.267 rg BT 347.044 642.238 Td /F1 9.8 Tf [( made suggestions to improve on-site medical care )] TJ ET BT 26.250 630.333 Td /F1 9.8 Tf [(\(Box 1\):)] TJ ET 0.965 0.965 0.965 rg 26.250 530.452 555.000 90.000 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 620.452 m 581.250 620.452 l 581.250 619.702 l 26.250 619.702 l f 26.250 530.452 m 581.250 530.452 l 581.250 531.202 l 26.250 531.202 l f q 225.000 0 0 70.500 35.250 540.202 cm /I4 Do Q q 35.250 534.202 537.000 0.000 re W n Q 0.271 0.267 0.267 rg BT 26.250 513.429 Td /F1 9.8 Tf [(On-site medical care has also dramatically improved following several stampedes occurring during the annual Islamic )] TJ ET BT 26.250 501.524 Td /F1 9.8 Tf [(pilgrimage of the Hajj [)] TJ ET 0.267 0.267 0.267 rg BT 123.243 501.524 Td /F1 9.8 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 134.085 501.524 Td /F1 9.8 Tf [(] . The most notable event in 2006 resulted in 346 deaths at a bottleneck area in the Mina Valley. The )] TJ ET BT 26.250 489.619 Td /F1 9.8 Tf [(provision of specially equipped medical care facilities, helipads, electronic surveillance, shading and cooling mists have helped )] TJ ET BT 26.250 477.714 Td /F1 9.8 Tf [(to reduce crowd morbidity and mortality [)] TJ ET 0.267 0.267 0.267 rg BT 201.809 477.714 Td /F1 9.8 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 212.651 477.714 Td /F1 9.8 Tf [(] . Local hospitals should also be involved with emergency planning in preparation )] TJ ET BT 26.250 465.810 Td /F1 9.8 Tf [(for potential mass gathering disasters. Madzimabuto [)] TJ ET 0.267 0.267 0.267 rg BT 257.637 465.810 Td /F1 9.8 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 268.479 465.810 Td /F1 9.8 Tf [(] , in a review of a stampede at a football match identified the following )] TJ ET BT 26.250 453.905 Td /F1 9.8 Tf [(hospital preparedness deficiencies identified as:)] TJ ET 0.271 0.267 0.267 RG 40.337 437.468 m 40.337 437.914 40.154 438.358 39.838 438.674 c 39.522 438.990 39.078 439.174 38.631 439.174 c 38.185 439.174 37.741 438.990 37.425 438.674 c 37.109 438.358 36.925 437.914 36.925 437.468 c 36.925 437.021 37.109 436.577 37.425 436.261 c 37.741 435.945 38.185 435.762 38.631 435.762 c 39.078 435.762 39.522 435.945 39.838 436.261 c 40.154 436.577 40.337 437.021 40.337 437.468 c f BT 45.750 434.500 Td /F1 9.8 Tf [(Emergency department only first aware when injured arrived)] TJ ET 40.337 421.813 m 40.337 422.260 40.154 422.704 39.838 423.020 c 39.522 423.335 39.078 423.519 38.631 423.519 c 38.185 423.519 37.741 423.335 37.425 423.020 c 37.109 422.704 36.925 422.260 36.925 421.813 c 36.925 421.366 37.109 420.922 37.425 420.606 c 37.741 420.291 38.185 420.107 38.631 420.107 c 39.078 420.107 39.522 420.291 39.838 420.606 c 40.154 420.922 40.337 421.366 40.337 421.813 c f BT 45.750 418.845 Td /F1 9.8 Tf [(No major incident plan was prepared which led to the emergency department being overwhelmed)] TJ ET 40.337 406.158 m 40.337 406.605 40.154 407.049 39.838 407.365 c 39.522 407.681 39.078 407.865 38.631 407.865 c 38.185 407.865 37.741 407.681 37.425 407.365 c 37.109 407.049 36.925 406.605 36.925 406.158 c 36.925 405.712 37.109 405.268 37.425 404.952 c 37.741 404.636 38.185 404.452 38.631 404.452 c 39.078 404.452 39.522 404.636 39.838 404.952 c 40.154 405.268 40.337 405.712 40.337 406.158 c f BT 45.750 403.191 Td /F1 9.8 Tf [(A hospital command centre was not set up)] TJ ET 40.337 390.504 m 40.337 390.950 40.154 391.394 39.838 391.710 c 39.522 392.026 39.078 392.210 38.631 392.210 c 38.185 392.210 37.741 392.026 37.425 391.710 c 37.109 391.394 36.925 390.950 36.925 390.504 c 36.925 390.057 37.109 389.613 37.425 389.297 c 37.741 388.981 38.185 388.797 38.631 388.797 c 39.078 388.797 39.522 388.981 39.838 389.297 c 40.154 389.613 40.337 390.057 40.337 390.504 c f BT 45.750 387.536 Td /F1 9.8 Tf [(Staff reinforcements were unable to be contacted)] TJ ET 40.337 374.849 m 40.337 375.295 40.154 375.739 39.838 376.055 c 39.522 376.371 39.078 376.555 38.631 376.555 c 38.185 376.555 37.741 376.371 37.425 376.055 c 37.109 375.739 36.925 375.295 36.925 374.849 c 36.925 374.402 37.109 373.958 37.425 373.642 c 37.741 373.326 38.185 373.143 38.631 373.143 c 39.078 373.143 39.522 373.326 39.838 373.642 c 40.154 373.958 40.337 374.402 40.337 374.849 c f BT 45.750 371.881 Td /F1 9.8 Tf [(Medical teams were not organised to prioritise mass casualty care)] TJ ET 40.337 359.194 m 40.337 359.641 40.154 360.085 39.838 360.401 c 39.522 360.716 39.078 360.900 38.631 360.900 c 38.185 360.900 37.741 360.716 37.425 360.401 c 37.109 360.085 36.925 359.641 36.925 359.194 c 36.925 358.747 37.109 358.303 37.425 357.987 c 37.741 357.672 38.185 357.488 38.631 357.488 c 39.078 357.488 39.522 357.672 39.838 357.987 c 40.154 358.303 40.337 358.747 40.337 359.194 c f BT 45.750 356.226 Td /F1 9.8 Tf [(The media arrived, distracting emergency department personnel)] TJ ET 40.337 343.539 m 40.337 343.986 40.154 344.430 39.838 344.746 c 39.522 345.062 39.078 345.246 38.631 345.246 c 38.185 345.246 37.741 345.062 37.425 344.746 c 37.109 344.430 36.925 343.986 36.925 343.539 c 36.925 343.093 37.109 342.649 37.425 342.333 c 37.741 342.017 38.185 341.833 38.631 341.833 c 39.078 341.833 39.522 342.017 39.838 342.333 c 40.154 342.649 40.337 343.093 40.337 343.539 c f BT 45.750 340.572 Td /F1 9.8 Tf [(Supporting hospitals were not involved in a timely manner)] TJ ET BT 26.250 317.417 Td /F1 9.8 Tf [(It is suggested that when planning for a mass gathering event, local hospitals should be involved in healthcare provision not )] TJ ET BT 26.250 305.512 Td /F1 9.8 Tf [(only on-site but also for their own planning of mass casualty events allowing for potential occurrence of disaster.)] TJ ET BT 26.250 286.107 Td /F1 9.8 Tf [(For mass gatherings on larger scale such as Olympic Games, an assessment of terrorism risk assessment might be necessary, )] TJ ET BT 26.250 274.203 Td /F1 9.8 Tf [(with further medical provisions available during these planned events. For example Feliciano et al )] TJ ET 0.267 0.267 0.267 rg BT 448.922 274.203 Td /F1 9.8 Tf [([24])] TJ ET 0.271 0.267 0.267 rg BT 465.185 274.203 Td /F1 9.8 Tf [( reported that there was )] TJ ET BT 26.250 262.298 Td /F1 9.8 Tf [(extensive pre-Olympics preparation \(Box\) at the regional Level 1 trauma centre before the Atlanta Games in 1996. In particular )] TJ ET BT 26.250 250.393 Td /F1 9.8 Tf [(the pre-hospital training \(point 4, box 2\) resulted in an excellent hospital-wide response to the multi-casualty event following the )] TJ ET BT 26.250 238.488 Td /F1 9.8 Tf [(explosion of a pipe-bomb in Centennial Park during these 1996 Olympics which resulted in 1 death and 21 injured on scene.)] TJ ET 0.965 0.965 0.965 rg 26.250 30.608 555.000 198.000 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 228.608 m 581.250 228.608 l 581.250 227.858 l 26.250 227.858 l f q 225.000 0 0 182.250 35.250 36.608 cm /I5 Do Q q 35.250 30.608 537.000 0.000 re W n Q Q q 15.000 30.608 577.500 746.392 re W n 0.271 0.267 0.267 rg 0.271 0.267 0.267 RG 40.337 770.444 m 40.337 770.890 40.154 771.334 39.838 771.650 c 39.522 771.966 39.078 772.150 38.631 772.150 c 38.185 772.150 37.741 771.966 37.425 771.650 c 37.109 771.334 36.925 770.890 36.925 770.444 c 36.925 769.997 37.109 769.553 37.425 769.237 c 37.741 768.921 38.185 768.738 38.631 768.738 c 39.078 768.738 39.522 768.921 39.838 769.237 c 40.154 769.553 40.337 769.997 40.337 770.444 c f BT 45.750 767.476 Td /F1 9.8 Tf [(Event employees should be allotted specific duties to be performed in the event of the fire, with regular fire drills held on the )] TJ ET BT 45.750 755.571 Td /F1 9.8 Tf [(premises.)] TJ ET 40.337 742.884 m 40.337 743.331 40.154 743.775 39.838 744.091 c 39.522 744.407 39.078 744.590 38.631 744.590 c 38.185 744.590 37.741 744.407 37.425 744.091 c 37.109 743.775 36.925 743.331 36.925 742.884 c 36.925 742.438 37.109 741.994 37.425 741.678 c 37.741 741.362 38.185 741.178 38.631 741.178 c 39.078 741.178 39.522 741.362 39.838 741.678 c 40.154 741.994 40.337 742.438 40.337 742.884 c f BT 45.750 739.917 Td /F1 9.8 Tf [(Full site fire evacuation plans are essential. These could include signage to evacuation points.)] TJ ET BT 26.250 716.762 Td /F4 9.8 Tf [(Medical Preparedness)] TJ ET BT 26.250 697.357 Td /F1 9.8 Tf [(Provision of on-site physician-level medical care at mass gatherings has been shown to significantly reduce the number of )] TJ ET BT 26.250 685.452 Td /F1 9.8 Tf [(patients requiring transport to hospital and therefore reducing the impact on the local ambulance services )] TJ ET 0.267 0.267 0.267 rg BT 482.004 685.452 Td /F1 9.8 Tf [([20])] TJ ET 0.271 0.267 0.267 rg BT 498.267 685.452 Td /F1 9.8 Tf [( . The majority of )] TJ ET BT 26.250 673.548 Td /F1 9.8 Tf [(non-disaster injuries and medical complaints at a mass gathering can be effectively treated on scene, which reduces the )] TJ ET BT 26.250 661.643 Td /F1 9.8 Tf [(number of hospital referrals and patient presentation rates to hospital )] TJ ET 0.267 0.267 0.267 rg BT 326.482 661.643 Td /F1 9.8 Tf [([21])] TJ ET 0.271 0.267 0.267 rg BT 342.745 661.643 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 642.238 Td /F1 9.8 Tf [(Following the Hillsborough Stadium disaster 1989, Lord Justice Taylor )] TJ ET 0.267 0.267 0.267 rg BT 330.781 642.238 Td /F1 9.8 Tf [([22])] TJ ET 0.271 0.267 0.267 rg BT 347.044 642.238 Td /F1 9.8 Tf [( made suggestions to improve on-site medical care )] TJ ET BT 26.250 630.333 Td /F1 9.8 Tf [(\(Box 1\):)] TJ ET 0.965 0.965 0.965 rg 26.250 530.452 555.000 90.000 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 620.452 m 581.250 620.452 l 581.250 619.702 l 26.250 619.702 l f 26.250 530.452 m 581.250 530.452 l 581.250 531.202 l 26.250 531.202 l f q 225.000 0 0 70.500 35.250 540.202 cm /I4 Do Q q 35.250 534.202 537.000 0.000 re W n Q 0.271 0.267 0.267 rg BT 26.250 513.429 Td /F1 9.8 Tf [(On-site medical care has also dramatically improved following several stampedes occurring during the annual Islamic )] TJ ET BT 26.250 501.524 Td /F1 9.8 Tf [(pilgrimage of the Hajj [)] TJ ET 0.267 0.267 0.267 rg BT 123.243 501.524 Td /F1 9.8 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 134.085 501.524 Td /F1 9.8 Tf [(] . The most notable event in 2006 resulted in 346 deaths at a bottleneck area in the Mina Valley. The )] TJ ET BT 26.250 489.619 Td /F1 9.8 Tf [(provision of specially equipped medical care facilities, helipads, electronic surveillance, shading and cooling mists have helped )] TJ ET BT 26.250 477.714 Td /F1 9.8 Tf [(to reduce crowd morbidity and mortality [)] TJ ET 0.267 0.267 0.267 rg BT 201.809 477.714 Td /F1 9.8 Tf [(10)] TJ ET 0.271 0.267 0.267 rg BT 212.651 477.714 Td /F1 9.8 Tf [(] . Local hospitals should also be involved with emergency planning in preparation )] TJ ET BT 26.250 465.810 Td /F1 9.8 Tf [(for potential mass gathering disasters. Madzimabuto [)] TJ ET 0.267 0.267 0.267 rg BT 257.637 465.810 Td /F1 9.8 Tf [(23)] TJ ET 0.271 0.267 0.267 rg BT 268.479 465.810 Td /F1 9.8 Tf [(] , in a review of a stampede at a football match identified the following )] TJ ET BT 26.250 453.905 Td /F1 9.8 Tf [(hospital preparedness deficiencies identified as:)] TJ ET 0.271 0.267 0.267 RG 40.337 437.468 m 40.337 437.914 40.154 438.358 39.838 438.674 c 39.522 438.990 39.078 439.174 38.631 439.174 c 38.185 439.174 37.741 438.990 37.425 438.674 c 37.109 438.358 36.925 437.914 36.925 437.468 c 36.925 437.021 37.109 436.577 37.425 436.261 c 37.741 435.945 38.185 435.762 38.631 435.762 c 39.078 435.762 39.522 435.945 39.838 436.261 c 40.154 436.577 40.337 437.021 40.337 437.468 c f BT 45.750 434.500 Td /F1 9.8 Tf [(Emergency department only first aware when injured arrived)] TJ ET 40.337 421.813 m 40.337 422.260 40.154 422.704 39.838 423.020 c 39.522 423.335 39.078 423.519 38.631 423.519 c 38.185 423.519 37.741 423.335 37.425 423.020 c 37.109 422.704 36.925 422.260 36.925 421.813 c 36.925 421.366 37.109 420.922 37.425 420.606 c 37.741 420.291 38.185 420.107 38.631 420.107 c 39.078 420.107 39.522 420.291 39.838 420.606 c 40.154 420.922 40.337 421.366 40.337 421.813 c f BT 45.750 418.845 Td /F1 9.8 Tf [(No major incident plan was prepared which led to the emergency department being overwhelmed)] TJ ET 40.337 406.158 m 40.337 406.605 40.154 407.049 39.838 407.365 c 39.522 407.681 39.078 407.865 38.631 407.865 c 38.185 407.865 37.741 407.681 37.425 407.365 c 37.109 407.049 36.925 406.605 36.925 406.158 c 36.925 405.712 37.109 405.268 37.425 404.952 c 37.741 404.636 38.185 404.452 38.631 404.452 c 39.078 404.452 39.522 404.636 39.838 404.952 c 40.154 405.268 40.337 405.712 40.337 406.158 c f BT 45.750 403.191 Td /F1 9.8 Tf [(A hospital command centre was not set up)] TJ ET 40.337 390.504 m 40.337 390.950 40.154 391.394 39.838 391.710 c 39.522 392.026 39.078 392.210 38.631 392.210 c 38.185 392.210 37.741 392.026 37.425 391.710 c 37.109 391.394 36.925 390.950 36.925 390.504 c 36.925 390.057 37.109 389.613 37.425 389.297 c 37.741 388.981 38.185 388.797 38.631 388.797 c 39.078 388.797 39.522 388.981 39.838 389.297 c 40.154 389.613 40.337 390.057 40.337 390.504 c f BT 45.750 387.536 Td /F1 9.8 Tf [(Staff reinforcements were unable to be contacted)] TJ ET 40.337 374.849 m 40.337 375.295 40.154 375.739 39.838 376.055 c 39.522 376.371 39.078 376.555 38.631 376.555 c 38.185 376.555 37.741 376.371 37.425 376.055 c 37.109 375.739 36.925 375.295 36.925 374.849 c 36.925 374.402 37.109 373.958 37.425 373.642 c 37.741 373.326 38.185 373.143 38.631 373.143 c 39.078 373.143 39.522 373.326 39.838 373.642 c 40.154 373.958 40.337 374.402 40.337 374.849 c f BT 45.750 371.881 Td /F1 9.8 Tf [(Medical teams were not organised to prioritise mass casualty care)] TJ ET 40.337 359.194 m 40.337 359.641 40.154 360.085 39.838 360.401 c 39.522 360.716 39.078 360.900 38.631 360.900 c 38.185 360.900 37.741 360.716 37.425 360.401 c 37.109 360.085 36.925 359.641 36.925 359.194 c 36.925 358.747 37.109 358.303 37.425 357.987 c 37.741 357.672 38.185 357.488 38.631 357.488 c 39.078 357.488 39.522 357.672 39.838 357.987 c 40.154 358.303 40.337 358.747 40.337 359.194 c f BT 45.750 356.226 Td /F1 9.8 Tf [(The media arrived, distracting emergency department personnel)] TJ ET 40.337 343.539 m 40.337 343.986 40.154 344.430 39.838 344.746 c 39.522 345.062 39.078 345.246 38.631 345.246 c 38.185 345.246 37.741 345.062 37.425 344.746 c 37.109 344.430 36.925 343.986 36.925 343.539 c 36.925 343.093 37.109 342.649 37.425 342.333 c 37.741 342.017 38.185 341.833 38.631 341.833 c 39.078 341.833 39.522 342.017 39.838 342.333 c 40.154 342.649 40.337 343.093 40.337 343.539 c f BT 45.750 340.572 Td /F1 9.8 Tf [(Supporting hospitals were not involved in a timely manner)] TJ ET BT 26.250 317.417 Td /F1 9.8 Tf [(It is suggested that when planning for a mass gathering event, local hospitals should be involved in healthcare provision not )] TJ ET BT 26.250 305.512 Td /F1 9.8 Tf [(only on-site but also for their own planning of mass casualty events allowing for potential occurrence of disaster.)] TJ ET BT 26.250 286.107 Td /F1 9.8 Tf [(For mass gatherings on larger scale such as Olympic Games, an assessment of terrorism risk assessment might be necessary, )] TJ ET BT 26.250 274.203 Td /F1 9.8 Tf [(with further medical provisions available during these planned events. For example Feliciano et al )] TJ ET 0.267 0.267 0.267 rg BT 448.922 274.203 Td /F1 9.8 Tf [([24])] TJ ET 0.271 0.267 0.267 rg BT 465.185 274.203 Td /F1 9.8 Tf [( reported that there was )] TJ ET BT 26.250 262.298 Td /F1 9.8 Tf [(extensive pre-Olympics preparation \(Box\) at the regional Level 1 trauma centre before the Atlanta Games in 1996. In particular )] TJ ET BT 26.250 250.393 Td /F1 9.8 Tf [(the pre-hospital training \(point 4, box 2\) resulted in an excellent hospital-wide response to the multi-casualty event following the )] TJ ET BT 26.250 238.488 Td /F1 9.8 Tf [(explosion of a pipe-bomb in Centennial Park during these 1996 Olympics which resulted in 1 death and 21 injured on scene.)] TJ ET 0.965 0.965 0.965 rg 26.250 30.608 555.000 198.000 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 228.608 m 581.250 228.608 l 581.250 227.858 l 26.250 227.858 l f q 225.000 0 0 182.250 35.250 36.608 cm /I5 Do Q q 35.250 30.608 537.000 0.000 re W n Q Q q 225.000 0 0 70.500 35.250 540.202 cm /I4 Do Q q 225.000 0 0 182.250 35.250 36.608 cm /I5 Do Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(4)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET 0.39 w 1 J 1 j Q endstream endobj 159 0 obj << /Type /Annot /Subtype /Link /A 160 0 R /Border [0 0 0] /H /I /Rect [ 482.0040 684.5506 498.2670 694.4712 ] >> endobj 160 0 obj << /Type /Action >> endobj 161 0 obj << /Type /Annot /Subtype /Link /A 162 0 R /Border [0 0 0] /H /I /Rect [ 326.4817 660.7411 342.7447 670.6617 ] >> endobj 162 0 obj << /Type /Action >> endobj 163 0 obj << /Type /Annot /Subtype /Link /A 164 0 R /Border [0 0 0] /H /I /Rect [ 330.7815 641.3363 347.0445 651.2569 ] >> endobj 164 0 obj << /Type /Action >> endobj 165 0 obj << /Type /Annot /Subtype /Link /A 166 0 R /Border [0 0 0] /H /I /Rect [ 35.2500 540.2025 260.2500 610.7025 ] >> endobj 166 0 obj << /Type /Action /S /URI /URI (https://currents.plos.org/disasters/files/2012/02/mass-disasters-box1.jpg) >> endobj 167 0 obj << /Type /XObject /Subtype /Image /Width 300 /Height 94 /ColorSpace /DeviceRGB /Filter /DCTDecode /BitsPerComponent 8 /Length 12783>> stream JFIF;CREATOR: gd-jpeg v1.0 (using IJG JPEG v62), quality = 90 C     C   ^," }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?ǍG2&[佹\E@09+7Vn4,.O\tH;ȻU7y}3??5^\ۙ:y$Is9J;7錊L{NTIj/Ǟ?h+sB! 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However, it is necessary to have one in place to co-ordinate fast and effective )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(emergency response, to potentially improve morbidity and mortality.)] TJ ET BT 26.250 704.857 Td /F1 9.8 Tf [(Poor initial communication with emergency medical services was a key finding in not only the Ramstein air show disaster )] TJ ET 0.267 0.267 0.267 rg BT 549.133 704.857 Td /F1 9.8 Tf [([13])] TJ ET 0.271 0.267 0.267 rg BT 565.396 704.857 Td /F1 9.8 Tf [( , )] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(but also in stampedes at the Miyun Country bridge disaster in China )] TJ ET 0.267 0.267 0.267 rg BT 321.587 692.952 Td /F1 9.8 Tf [([25])] TJ ET 0.271 0.267 0.267 rg BT 337.850 692.952 Td /F1 9.8 Tf [( , the Akashi firework event in Japan )] TJ ET 0.267 0.267 0.267 rg BT 497.175 692.952 Td /F1 9.8 Tf [([26])] TJ ET 0.271 0.267 0.267 rg BT 513.438 692.952 Td /F1 9.8 Tf [( and at a )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(religious temple in Uttar Pradesh )] TJ ET 0.267 0.267 0.267 rg BT 170.384 681.048 Td /F1 9.8 Tf [([27])] TJ ET 0.271 0.267 0.267 rg BT 186.647 681.048 Td /F1 9.8 Tf [( . These highlighted poor triage of casualties. Indeed in one instance it was triage was )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(initiated approximately 80 minutes after the incident occurred )] TJ ET 0.267 0.267 0.267 rg BT 291.781 669.143 Td /F1 9.8 Tf [([26])] TJ ET 0.271 0.267 0.267 rg BT 308.044 669.143 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 649.738 Td /F1 9.8 Tf [(It has been suggested that emergency planning has considered that emergency personnel on-site have adequate training and )] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(experience in disaster medicine, utilising appropriate triage methods. One analysis of medical care at mass gatherings by )] TJ ET BT 26.250 625.929 Td /F1 9.8 Tf [(Sanders et al )] TJ ET 0.267 0.267 0.267 rg BT 86.407 625.929 Td /F1 9.8 Tf [([28] )] TJ ET 0.271 0.267 0.267 rg BT 105.381 625.929 Td /F1 9.8 Tf [(suggested:)] TJ ET 0.271 0.267 0.267 RG 40.337 609.491 m 40.337 609.938 40.154 610.382 39.838 610.698 c 39.522 611.014 39.078 611.198 38.631 611.198 c 38.185 611.198 37.741 611.014 37.425 610.698 c 37.109 610.382 36.925 609.938 36.925 609.491 c 36.925 609.045 37.109 608.601 37.425 608.285 c 37.741 607.969 38.185 607.785 38.631 607.785 c 39.078 607.785 39.522 607.969 39.838 608.285 c 40.154 608.601 40.337 609.045 40.337 609.491 c f BT 45.750 606.524 Td /F1 9.8 Tf [(Basic first aid within 4 minutes)] TJ ET 40.337 593.837 m 40.337 594.283 40.154 594.727 39.838 595.043 c 39.522 595.359 39.078 595.543 38.631 595.543 c 38.185 595.543 37.741 595.359 37.425 595.043 c 37.109 594.727 36.925 594.283 36.925 593.837 c 36.925 593.390 37.109 592.946 37.425 592.630 c 37.741 592.314 38.185 592.130 38.631 592.130 c 39.078 592.130 39.522 592.314 39.838 592.630 c 40.154 592.946 40.337 593.390 40.337 593.837 c f BT 45.750 590.869 Td /F1 9.8 Tf [(Advanced Life Support within 8 minutes)] TJ ET 40.337 578.182 m 40.337 578.629 40.154 579.073 39.838 579.389 c 39.522 579.704 39.078 579.888 38.631 579.888 c 38.185 579.888 37.741 579.704 37.425 579.389 c 37.109 579.073 36.925 578.629 36.925 578.182 c 36.925 577.735 37.109 577.291 37.425 576.975 c 37.741 576.660 38.185 576.476 38.631 576.476 c 39.078 576.476 39.522 576.660 39.838 576.975 c 40.154 577.291 40.337 577.735 40.337 578.182 c f BT 45.750 575.214 Td /F1 9.8 Tf [(Evacuation to a medical facility within 30 minutes.)] TJ ET BT 26.250 552.060 Td /F1 9.8 Tf [(However these suggestions are based on only low patient numbers requiring triage, and arose from low-level evidence and )] TJ ET BT 26.250 540.155 Td /F1 9.8 Tf [(expert judgement, which the authors stressed is in need of further research )] TJ ET 0.267 0.267 0.267 rg BT 352.485 540.155 Td /F1 9.8 Tf [([28])] TJ ET 0.271 0.267 0.267 rg BT 368.748 540.155 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 520.750 Td /F1 9.8 Tf [(Event preplanning using these principles has been described by )] TJ ET 0.267 0.267 0.267 rg BT 304.808 520.750 Td /F1 9.8 Tf [([12])] TJ ET 0.271 0.267 0.267 rg BT 321.070 520.750 Td /F1 9.8 Tf [( in relation to the 2010 Love Parade in Germany when )] TJ ET BT 26.250 508.845 Td /F1 9.8 Tf [(major medical preparations were put in place. They reported on patient care delivery at this mass gathering, where following a )] TJ ET BT 26.250 496.941 Td /F1 9.8 Tf [(stampede, 21 died and over 510 were injured. Once a disaster was called at the site, additional emergency healthcare )] TJ ET BT 26.250 485.036 Td /F1 9.8 Tf [(personnel were brought in, and extra treatment facilities were created to deal with the situation. First-aid posts and emergency )] TJ ET BT 26.250 473.131 Td /F1 9.8 Tf [(treatment and triage stations were set up on site, dealing with a high volume of patients. The formation of trauma teams made it )] TJ ET BT 26.250 461.226 Td /F1 9.8 Tf [(possible to control patient flows appropriately to all hospitals. However, even with such well planned emergency response, )] TJ ET BT 26.250 449.322 Td /F1 9.8 Tf [(adverse consequences occurred which demonstrates again the complexity of planning for such mass gathering events.)] TJ ET BT 26.250 412.719 Td /F4 12.0 Tf [(Summary)] TJ ET BT 26.250 392.765 Td /F1 9.8 Tf [(Mass gathering events have a potential to place a severe strain on the local health care system, with a mixture of high crowd )] TJ ET BT 26.250 380.860 Td /F1 9.8 Tf [(density, restricted points of access, limited crowd control and lack of sufficient on-site medical care and emergency response )] TJ ET BT 26.250 368.955 Td /F1 9.8 Tf [(can increase the risk of disaster.)] TJ ET BT 26.250 349.551 Td /F1 9.8 Tf [(Many challenges are faced by mass gathering event organisers, medical resource planners, and emergency services, including )] TJ ET BT 26.250 337.646 Td /F1 9.8 Tf [(local hospital emergency departments in order to provide a safe event. Analysis of previous crowd disasters indicates a need for )] TJ ET BT 26.250 325.741 Td /F1 9.8 Tf [(early detailed planning of crowd policies, evacuation procedures and involvement of emergency services which are necessary )] TJ ET BT 26.250 313.836 Td /F1 9.8 Tf [(to promote and provide a successful event. This review highlights several key considerations that could impact on health )] TJ ET BT 26.250 301.932 Td /F1 9.8 Tf [(resources include:)] TJ ET 40.337 285.495 m 40.337 285.941 40.154 286.385 39.838 286.701 c 39.522 287.017 39.078 287.201 38.631 287.201 c 38.185 287.201 37.741 287.017 37.425 286.701 c 37.109 286.385 36.925 285.941 36.925 285.495 c 36.925 285.048 37.109 284.604 37.425 284.288 c 37.741 283.972 38.185 283.788 38.631 283.788 c 39.078 283.788 39.522 283.972 39.838 284.288 c 40.154 284.604 40.337 285.048 40.337 285.495 c f BT 45.750 282.527 Td /F1 9.8 Tf [(Preplanning for mass gathering events is key and should include health management and major incident planning.)] TJ ET 40.337 269.840 m 40.337 270.286 40.154 270.730 39.838 271.046 c 39.522 271.362 39.078 271.546 38.631 271.546 c 38.185 271.546 37.741 271.362 37.425 271.046 c 37.109 270.730 36.925 270.286 36.925 269.840 c 36.925 269.393 37.109 268.949 37.425 268.633 c 37.741 268.317 38.185 268.134 38.631 268.134 c 39.078 268.134 39.522 268.317 39.838 268.633 c 40.154 268.949 40.337 269.393 40.337 269.840 c f BT 45.750 266.872 Td /F1 9.8 Tf [(Adequate crowd security and emergency medical services need to be provided at a mass gatherings taking account of )] TJ ET BT 45.750 254.967 Td /F1 9.8 Tf [(crowd size and factors such as event type and external environmental conditions.)] TJ ET 40.337 242.280 m 40.337 242.727 40.154 243.171 39.838 243.487 c 39.522 243.803 39.078 243.987 38.631 243.987 c 38.185 243.987 37.741 243.803 37.425 243.487 c 37.109 243.171 36.925 242.727 36.925 242.280 c 36.925 241.834 37.109 241.390 37.425 241.074 c 37.741 240.758 38.185 240.574 38.631 240.574 c 39.078 240.574 39.522 240.758 39.838 241.074 c 40.154 241.390 40.337 241.834 40.337 242.280 c f BT 45.750 239.313 Td /F1 9.8 Tf [(Emergency Medical Services with adequate training and experience, in the management of multiple medical casualties )] TJ ET BT 45.750 227.408 Td /F1 9.8 Tf [(need to be available. Pre-planning with local hospitals will aid the emergency response.)] TJ ET 40.337 214.721 m 40.337 215.167 40.154 215.611 39.838 215.927 c 39.522 216.243 39.078 216.427 38.631 216.427 c 38.185 216.427 37.741 216.243 37.425 215.927 c 37.109 215.611 36.925 215.167 36.925 214.721 c 36.925 214.274 37.109 213.830 37.425 213.514 c 37.741 213.198 38.185 213.015 38.631 213.015 c 39.078 213.015 39.522 213.198 39.838 213.514 c 40.154 213.830 40.337 214.274 40.337 214.721 c f BT 45.750 211.753 Td /F1 9.8 Tf [(Health planning should include: )] TJ ET 0.39 w 1 J 1 j 59.837 199.066 m 59.837 199.513 59.654 199.957 59.338 200.273 c 59.022 200.588 58.578 200.772 58.131 200.772 c 57.685 200.772 57.241 200.588 56.925 200.273 c 56.609 199.957 56.425 199.513 56.425 199.066 c 56.425 198.619 56.609 198.175 56.925 197.859 c 57.241 197.544 57.685 197.360 58.131 197.360 c 58.578 197.360 59.022 197.544 59.338 197.859 c 59.654 198.175 59.837 198.619 59.837 199.066 c s BT 65.250 196.098 Td /F1 9.8 Tf [(Training of stewards and security staff in crowd control)] TJ ET 0.39 w 1 J 1 j 59.837 183.411 m 59.837 183.858 59.654 184.302 59.338 184.618 c 59.022 184.934 58.578 185.118 58.131 185.118 c 57.685 185.118 57.241 184.934 56.925 184.618 c 56.609 184.302 56.425 183.858 56.425 183.411 c 56.425 182.965 56.609 182.521 56.925 182.205 c 57.241 181.889 57.685 181.705 58.131 181.705 c 58.578 181.705 59.022 181.889 59.338 182.205 c 59.654 182.521 59.837 182.965 59.837 183.411 c s BT 65.250 180.444 Td /F1 9.8 Tf [(An adequate ticketing system to limit overcrowding)] TJ ET 0.39 w 1 J 1 j 59.837 167.757 m 59.837 168.203 59.654 168.647 59.338 168.963 c 59.022 169.279 58.578 169.463 58.131 169.463 c 57.685 169.463 57.241 169.279 56.925 168.963 c 56.609 168.647 56.425 168.203 56.425 167.757 c 56.425 167.310 56.609 166.866 56.925 166.550 c 57.241 166.234 57.685 166.050 58.131 166.050 c 58.578 166.050 59.022 166.234 59.338 166.550 c 59.654 166.866 59.837 167.310 59.837 167.757 c s BT 65.250 164.789 Td /F1 9.8 Tf [(A functioning and adequate public address system)] TJ ET 0.39 w 1 J 1 j 59.837 152.102 m 59.837 152.548 59.654 152.992 59.338 153.308 c 59.022 153.624 58.578 153.808 58.131 153.808 c 57.685 153.808 57.241 153.624 56.925 153.308 c 56.609 152.992 56.425 152.548 56.425 152.102 c 56.425 151.655 56.609 151.211 56.925 150.895 c 57.241 150.579 57.685 150.396 58.131 150.396 c 58.578 150.396 59.022 150.579 59.338 150.895 c 59.654 151.211 59.837 151.655 59.837 152.102 c s BT 65.250 149.134 Td /F1 9.8 Tf [(Specified entrance and exit points to an event to help ensure a unidirectional flow of crowd)] TJ ET 40.337 132.697 m 40.337 133.144 40.154 133.588 39.838 133.904 c 39.522 134.219 39.078 134.403 38.631 134.403 c 38.185 134.403 37.741 134.219 37.425 133.904 c 37.109 133.588 36.925 133.144 36.925 132.697 c 36.925 132.250 37.109 131.806 37.425 131.490 c 37.741 131.175 38.185 130.991 38.631 130.991 c 39.078 130.991 39.522 131.175 39.838 131.490 c 40.154 131.806 40.337 132.250 40.337 132.697 c f BT 45.750 129.729 Td /F1 9.8 Tf [(Evacuation plans including fire safety should be available for all mass gathering events with information passed on to )] TJ ET BT 45.750 117.825 Td /F1 9.8 Tf [(attendees in a clear fashion. Exit routes should be clear and free from obstruction, and plans should be in place for co-)] TJ ET BT 45.750 105.920 Td /F1 9.8 Tf [(ordinated and safe evacuation.)] TJ ET 40.337 93.233 m 40.337 93.679 40.154 94.123 39.838 94.439 c 39.522 94.755 39.078 94.939 38.631 94.939 c 38.185 94.939 37.741 94.755 37.425 94.439 c 37.109 94.123 36.925 93.679 36.925 93.233 c 36.925 92.786 37.109 92.342 37.425 92.026 c 37.741 91.710 38.185 91.527 38.631 91.527 c 39.078 91.527 39.522 91.710 39.838 92.026 c 40.154 92.342 40.337 92.786 40.337 93.233 c f BT 45.750 90.265 Td /F1 9.8 Tf [(Every mass gathering event should have a major incident and mass casualty plan which should be activated in the event of )] TJ ET BT 45.750 78.360 Td /F1 9.8 Tf [(a disaster.)] TJ ET BT 26.250 55.206 Td /F1 9.8 Tf [(Further studies of mass gathering events are warranted to advance not only the epidemiological knowledge base, but also to )] TJ ET BT 26.250 43.301 Td /F1 9.8 Tf [(gain further lessons of emergency preparedness and response.)] TJ ET Q q 15.000 40.920 577.500 736.080 re W n 0.965 0.965 0.965 rg 26.250 777.000 555.000 0.000 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 777.000 m 581.250 777.000 l 581.250 777.750 l 26.250 777.750 l f q 35.250 777.000 537.000 0.000 re W n Q 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F4 9.8 Tf [(Emergency Response)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Many of the case reports highlighted a poor response time for emergency services but it is unknown if each event reviewed had )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(a mass gathering major incident plan available. However, it is necessary to have one in place to co-ordinate fast and effective )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(emergency response, to potentially improve morbidity and mortality.)] TJ ET BT 26.250 704.857 Td /F1 9.8 Tf [(Poor initial communication with emergency medical services was a key finding in not only the Ramstein air show disaster )] TJ ET 0.267 0.267 0.267 rg BT 549.133 704.857 Td /F1 9.8 Tf [([13])] TJ ET 0.271 0.267 0.267 rg BT 565.396 704.857 Td /F1 9.8 Tf [( , )] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(but also in stampedes at the Miyun Country bridge disaster in China )] TJ ET 0.267 0.267 0.267 rg BT 321.587 692.952 Td /F1 9.8 Tf [([25])] TJ ET 0.271 0.267 0.267 rg BT 337.850 692.952 Td /F1 9.8 Tf [( , the Akashi firework event in Japan )] TJ ET 0.267 0.267 0.267 rg BT 497.175 692.952 Td /F1 9.8 Tf [([26])] TJ ET 0.271 0.267 0.267 rg BT 513.438 692.952 Td /F1 9.8 Tf [( and at a )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(religious temple in Uttar Pradesh )] TJ ET 0.267 0.267 0.267 rg BT 170.384 681.048 Td /F1 9.8 Tf [([27])] TJ ET 0.271 0.267 0.267 rg BT 186.647 681.048 Td /F1 9.8 Tf [( . These highlighted poor triage of casualties. Indeed in one instance it was triage was )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(initiated approximately 80 minutes after the incident occurred )] TJ ET 0.267 0.267 0.267 rg BT 291.781 669.143 Td /F1 9.8 Tf [([26])] TJ ET 0.271 0.267 0.267 rg BT 308.044 669.143 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 649.738 Td /F1 9.8 Tf [(It has been suggested that emergency planning has considered that emergency personnel on-site have adequate training and )] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(experience in disaster medicine, utilising appropriate triage methods. One analysis of medical care at mass gatherings by )] TJ ET BT 26.250 625.929 Td /F1 9.8 Tf [(Sanders et al )] TJ ET 0.267 0.267 0.267 rg BT 86.407 625.929 Td /F1 9.8 Tf [([28] )] TJ ET 0.271 0.267 0.267 rg BT 105.381 625.929 Td /F1 9.8 Tf [(suggested:)] TJ ET 0.271 0.267 0.267 RG 40.337 609.491 m 40.337 609.938 40.154 610.382 39.838 610.698 c 39.522 611.014 39.078 611.198 38.631 611.198 c 38.185 611.198 37.741 611.014 37.425 610.698 c 37.109 610.382 36.925 609.938 36.925 609.491 c 36.925 609.045 37.109 608.601 37.425 608.285 c 37.741 607.969 38.185 607.785 38.631 607.785 c 39.078 607.785 39.522 607.969 39.838 608.285 c 40.154 608.601 40.337 609.045 40.337 609.491 c f BT 45.750 606.524 Td /F1 9.8 Tf [(Basic first aid within 4 minutes)] TJ ET 40.337 593.837 m 40.337 594.283 40.154 594.727 39.838 595.043 c 39.522 595.359 39.078 595.543 38.631 595.543 c 38.185 595.543 37.741 595.359 37.425 595.043 c 37.109 594.727 36.925 594.283 36.925 593.837 c 36.925 593.390 37.109 592.946 37.425 592.630 c 37.741 592.314 38.185 592.130 38.631 592.130 c 39.078 592.130 39.522 592.314 39.838 592.630 c 40.154 592.946 40.337 593.390 40.337 593.837 c f BT 45.750 590.869 Td /F1 9.8 Tf [(Advanced Life Support within 8 minutes)] TJ ET 40.337 578.182 m 40.337 578.629 40.154 579.073 39.838 579.389 c 39.522 579.704 39.078 579.888 38.631 579.888 c 38.185 579.888 37.741 579.704 37.425 579.389 c 37.109 579.073 36.925 578.629 36.925 578.182 c 36.925 577.735 37.109 577.291 37.425 576.975 c 37.741 576.660 38.185 576.476 38.631 576.476 c 39.078 576.476 39.522 576.660 39.838 576.975 c 40.154 577.291 40.337 577.735 40.337 578.182 c f BT 45.750 575.214 Td /F1 9.8 Tf [(Evacuation to a medical facility within 30 minutes.)] TJ ET BT 26.250 552.060 Td /F1 9.8 Tf [(However these suggestions are based on only low patient numbers requiring triage, and arose from low-level evidence and )] TJ ET BT 26.250 540.155 Td /F1 9.8 Tf [(expert judgement, which the authors stressed is in need of further research )] TJ ET 0.267 0.267 0.267 rg BT 352.485 540.155 Td /F1 9.8 Tf [([28])] TJ ET 0.271 0.267 0.267 rg BT 368.748 540.155 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 520.750 Td /F1 9.8 Tf [(Event preplanning using these principles has been described by )] TJ ET 0.267 0.267 0.267 rg BT 304.808 520.750 Td /F1 9.8 Tf [([12])] TJ ET 0.271 0.267 0.267 rg BT 321.070 520.750 Td /F1 9.8 Tf [( in relation to the 2010 Love Parade in Germany when )] TJ ET BT 26.250 508.845 Td /F1 9.8 Tf [(major medical preparations were put in place. They reported on patient care delivery at this mass gathering, where following a )] TJ ET BT 26.250 496.941 Td /F1 9.8 Tf [(stampede, 21 died and over 510 were injured. Once a disaster was called at the site, additional emergency healthcare )] TJ ET BT 26.250 485.036 Td /F1 9.8 Tf [(personnel were brought in, and extra treatment facilities were created to deal with the situation. First-aid posts and emergency )] TJ ET BT 26.250 473.131 Td /F1 9.8 Tf [(treatment and triage stations were set up on site, dealing with a high volume of patients. The formation of trauma teams made it )] TJ ET BT 26.250 461.226 Td /F1 9.8 Tf [(possible to control patient flows appropriately to all hospitals. However, even with such well planned emergency response, )] TJ ET BT 26.250 449.322 Td /F1 9.8 Tf [(adverse consequences occurred which demonstrates again the complexity of planning for such mass gathering events.)] TJ ET BT 26.250 412.719 Td /F4 12.0 Tf [(Summary)] TJ ET BT 26.250 392.765 Td /F1 9.8 Tf [(Mass gathering events have a potential to place a severe strain on the local health care system, with a mixture of high crowd )] TJ ET BT 26.250 380.860 Td /F1 9.8 Tf [(density, restricted points of access, limited crowd control and lack of sufficient on-site medical care and emergency response )] TJ ET BT 26.250 368.955 Td /F1 9.8 Tf [(can increase the risk of disaster.)] TJ ET BT 26.250 349.551 Td /F1 9.8 Tf [(Many challenges are faced by mass gathering event organisers, medical resource planners, and emergency services, including )] TJ ET BT 26.250 337.646 Td /F1 9.8 Tf [(local hospital emergency departments in order to provide a safe event. Analysis of previous crowd disasters indicates a need for )] TJ ET BT 26.250 325.741 Td /F1 9.8 Tf [(early detailed planning of crowd policies, evacuation procedures and involvement of emergency services which are necessary )] TJ ET BT 26.250 313.836 Td /F1 9.8 Tf [(to promote and provide a successful event. This review highlights several key considerations that could impact on health )] TJ ET BT 26.250 301.932 Td /F1 9.8 Tf [(resources include:)] TJ ET 40.337 285.495 m 40.337 285.941 40.154 286.385 39.838 286.701 c 39.522 287.017 39.078 287.201 38.631 287.201 c 38.185 287.201 37.741 287.017 37.425 286.701 c 37.109 286.385 36.925 285.941 36.925 285.495 c 36.925 285.048 37.109 284.604 37.425 284.288 c 37.741 283.972 38.185 283.788 38.631 283.788 c 39.078 283.788 39.522 283.972 39.838 284.288 c 40.154 284.604 40.337 285.048 40.337 285.495 c f BT 45.750 282.527 Td /F1 9.8 Tf [(Preplanning for mass gathering events is key and should include health management and major incident planning.)] TJ ET 40.337 269.840 m 40.337 270.286 40.154 270.730 39.838 271.046 c 39.522 271.362 39.078 271.546 38.631 271.546 c 38.185 271.546 37.741 271.362 37.425 271.046 c 37.109 270.730 36.925 270.286 36.925 269.840 c 36.925 269.393 37.109 268.949 37.425 268.633 c 37.741 268.317 38.185 268.134 38.631 268.134 c 39.078 268.134 39.522 268.317 39.838 268.633 c 40.154 268.949 40.337 269.393 40.337 269.840 c f BT 45.750 266.872 Td /F1 9.8 Tf [(Adequate crowd security and emergency medical services need to be provided at a mass gatherings taking account of )] TJ ET BT 45.750 254.967 Td /F1 9.8 Tf [(crowd size and factors such as event type and external environmental conditions.)] TJ ET 40.337 242.280 m 40.337 242.727 40.154 243.171 39.838 243.487 c 39.522 243.803 39.078 243.987 38.631 243.987 c 38.185 243.987 37.741 243.803 37.425 243.487 c 37.109 243.171 36.925 242.727 36.925 242.280 c 36.925 241.834 37.109 241.390 37.425 241.074 c 37.741 240.758 38.185 240.574 38.631 240.574 c 39.078 240.574 39.522 240.758 39.838 241.074 c 40.154 241.390 40.337 241.834 40.337 242.280 c f BT 45.750 239.313 Td /F1 9.8 Tf [(Emergency Medical Services with adequate training and experience, in the management of multiple medical casualties )] TJ ET BT 45.750 227.408 Td /F1 9.8 Tf [(need to be available. Pre-planning with local hospitals will aid the emergency response.)] TJ ET 40.337 214.721 m 40.337 215.167 40.154 215.611 39.838 215.927 c 39.522 216.243 39.078 216.427 38.631 216.427 c 38.185 216.427 37.741 216.243 37.425 215.927 c 37.109 215.611 36.925 215.167 36.925 214.721 c 36.925 214.274 37.109 213.830 37.425 213.514 c 37.741 213.198 38.185 213.015 38.631 213.015 c 39.078 213.015 39.522 213.198 39.838 213.514 c 40.154 213.830 40.337 214.274 40.337 214.721 c f BT 45.750 211.753 Td /F1 9.8 Tf [(Health planning should include: )] TJ ET 0.39 w 1 J 1 j 59.837 199.066 m 59.837 199.513 59.654 199.957 59.338 200.273 c 59.022 200.588 58.578 200.772 58.131 200.772 c 57.685 200.772 57.241 200.588 56.925 200.273 c 56.609 199.957 56.425 199.513 56.425 199.066 c 56.425 198.619 56.609 198.175 56.925 197.859 c 57.241 197.544 57.685 197.360 58.131 197.360 c 58.578 197.360 59.022 197.544 59.338 197.859 c 59.654 198.175 59.837 198.619 59.837 199.066 c s BT 65.250 196.098 Td /F1 9.8 Tf [(Training of stewards and security staff in crowd control)] TJ ET 0.39 w 1 J 1 j 59.837 183.411 m 59.837 183.858 59.654 184.302 59.338 184.618 c 59.022 184.934 58.578 185.118 58.131 185.118 c 57.685 185.118 57.241 184.934 56.925 184.618 c 56.609 184.302 56.425 183.858 56.425 183.411 c 56.425 182.965 56.609 182.521 56.925 182.205 c 57.241 181.889 57.685 181.705 58.131 181.705 c 58.578 181.705 59.022 181.889 59.338 182.205 c 59.654 182.521 59.837 182.965 59.837 183.411 c s BT 65.250 180.444 Td /F1 9.8 Tf [(An adequate ticketing system to limit overcrowding)] TJ ET 0.39 w 1 J 1 j 59.837 167.757 m 59.837 168.203 59.654 168.647 59.338 168.963 c 59.022 169.279 58.578 169.463 58.131 169.463 c 57.685 169.463 57.241 169.279 56.925 168.963 c 56.609 168.647 56.425 168.203 56.425 167.757 c 56.425 167.310 56.609 166.866 56.925 166.550 c 57.241 166.234 57.685 166.050 58.131 166.050 c 58.578 166.050 59.022 166.234 59.338 166.550 c 59.654 166.866 59.837 167.310 59.837 167.757 c s BT 65.250 164.789 Td /F1 9.8 Tf [(A functioning and adequate public address system)] TJ ET 0.39 w 1 J 1 j 59.837 152.102 m 59.837 152.548 59.654 152.992 59.338 153.308 c 59.022 153.624 58.578 153.808 58.131 153.808 c 57.685 153.808 57.241 153.624 56.925 153.308 c 56.609 152.992 56.425 152.548 56.425 152.102 c 56.425 151.655 56.609 151.211 56.925 150.895 c 57.241 150.579 57.685 150.396 58.131 150.396 c 58.578 150.396 59.022 150.579 59.338 150.895 c 59.654 151.211 59.837 151.655 59.837 152.102 c s BT 65.250 149.134 Td /F1 9.8 Tf [(Specified entrance and exit points to an event to help ensure a unidirectional flow of crowd)] TJ ET 40.337 132.697 m 40.337 133.144 40.154 133.588 39.838 133.904 c 39.522 134.219 39.078 134.403 38.631 134.403 c 38.185 134.403 37.741 134.219 37.425 133.904 c 37.109 133.588 36.925 133.144 36.925 132.697 c 36.925 132.250 37.109 131.806 37.425 131.490 c 37.741 131.175 38.185 130.991 38.631 130.991 c 39.078 130.991 39.522 131.175 39.838 131.490 c 40.154 131.806 40.337 132.250 40.337 132.697 c f BT 45.750 129.729 Td /F1 9.8 Tf [(Evacuation plans including fire safety should be available for all mass gathering events with information passed on to )] TJ ET BT 45.750 117.825 Td /F1 9.8 Tf [(attendees in a clear fashion. Exit routes should be clear and free from obstruction, and plans should be in place for co-)] TJ ET BT 45.750 105.920 Td /F1 9.8 Tf [(ordinated and safe evacuation.)] TJ ET 40.337 93.233 m 40.337 93.679 40.154 94.123 39.838 94.439 c 39.522 94.755 39.078 94.939 38.631 94.939 c 38.185 94.939 37.741 94.755 37.425 94.439 c 37.109 94.123 36.925 93.679 36.925 93.233 c 36.925 92.786 37.109 92.342 37.425 92.026 c 37.741 91.710 38.185 91.527 38.631 91.527 c 39.078 91.527 39.522 91.710 39.838 92.026 c 40.154 92.342 40.337 92.786 40.337 93.233 c f BT 45.750 90.265 Td /F1 9.8 Tf [(Every mass gathering event should have a major incident and mass casualty plan which should be activated in the event of )] TJ ET BT 45.750 78.360 Td /F1 9.8 Tf [(a disaster.)] TJ ET BT 26.250 55.206 Td /F1 9.8 Tf [(Further studies of mass gathering events are warranted to advance not only the epidemiological knowledge base, but also to )] TJ ET BT 26.250 43.301 Td /F1 9.8 Tf [(gain further lessons of emergency preparedness and response.)] TJ ET Q q 15.000 40.920 577.500 736.080 re W n 0.965 0.965 0.965 rg 26.250 777.000 555.000 0.000 re f 0.267 0.267 0.267 rg 0.267 0.267 0.267 RG 26.250 777.000 m 581.250 777.000 l 581.250 777.750 l 26.250 777.750 l f q 35.250 777.000 537.000 0.000 re W n Q 0.271 0.267 0.267 rg BT 26.250 767.476 Td /F4 9.8 Tf [(Emergency Response)] TJ ET BT 26.250 748.071 Td /F1 9.8 Tf [(Many of the case reports highlighted a poor response time for emergency services but it is unknown if each event reviewed had )] TJ ET BT 26.250 736.167 Td /F1 9.8 Tf [(a mass gathering major incident plan available. However, it is necessary to have one in place to co-ordinate fast and effective )] TJ ET BT 26.250 724.262 Td /F1 9.8 Tf [(emergency response, to potentially improve morbidity and mortality.)] TJ ET BT 26.250 704.857 Td /F1 9.8 Tf [(Poor initial communication with emergency medical services was a key finding in not only the Ramstein air show disaster )] TJ ET 0.267 0.267 0.267 rg BT 549.133 704.857 Td /F1 9.8 Tf [([13])] TJ ET 0.271 0.267 0.267 rg BT 565.396 704.857 Td /F1 9.8 Tf [( , )] TJ ET BT 26.250 692.952 Td /F1 9.8 Tf [(but also in stampedes at the Miyun Country bridge disaster in China )] TJ ET 0.267 0.267 0.267 rg BT 321.587 692.952 Td /F1 9.8 Tf [([25])] TJ ET 0.271 0.267 0.267 rg BT 337.850 692.952 Td /F1 9.8 Tf [( , the Akashi firework event in Japan )] TJ ET 0.267 0.267 0.267 rg BT 497.175 692.952 Td /F1 9.8 Tf [([26])] TJ ET 0.271 0.267 0.267 rg BT 513.438 692.952 Td /F1 9.8 Tf [( and at a )] TJ ET BT 26.250 681.048 Td /F1 9.8 Tf [(religious temple in Uttar Pradesh )] TJ ET 0.267 0.267 0.267 rg BT 170.384 681.048 Td /F1 9.8 Tf [([27])] TJ ET 0.271 0.267 0.267 rg BT 186.647 681.048 Td /F1 9.8 Tf [( . These highlighted poor triage of casualties. Indeed in one instance it was triage was )] TJ ET BT 26.250 669.143 Td /F1 9.8 Tf [(initiated approximately 80 minutes after the incident occurred )] TJ ET 0.267 0.267 0.267 rg BT 291.781 669.143 Td /F1 9.8 Tf [([26])] TJ ET 0.271 0.267 0.267 rg BT 308.044 669.143 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 649.738 Td /F1 9.8 Tf [(It has been suggested that emergency planning has considered that emergency personnel on-site have adequate training and )] TJ ET BT 26.250 637.833 Td /F1 9.8 Tf [(experience in disaster medicine, utilising appropriate triage methods. One analysis of medical care at mass gatherings by )] TJ ET BT 26.250 625.929 Td /F1 9.8 Tf [(Sanders et al )] TJ ET 0.267 0.267 0.267 rg BT 86.407 625.929 Td /F1 9.8 Tf [([28] )] TJ ET 0.271 0.267 0.267 rg BT 105.381 625.929 Td /F1 9.8 Tf [(suggested:)] TJ ET 0.271 0.267 0.267 RG 40.337 609.491 m 40.337 609.938 40.154 610.382 39.838 610.698 c 39.522 611.014 39.078 611.198 38.631 611.198 c 38.185 611.198 37.741 611.014 37.425 610.698 c 37.109 610.382 36.925 609.938 36.925 609.491 c 36.925 609.045 37.109 608.601 37.425 608.285 c 37.741 607.969 38.185 607.785 38.631 607.785 c 39.078 607.785 39.522 607.969 39.838 608.285 c 40.154 608.601 40.337 609.045 40.337 609.491 c f BT 45.750 606.524 Td /F1 9.8 Tf [(Basic first aid within 4 minutes)] TJ ET 40.337 593.837 m 40.337 594.283 40.154 594.727 39.838 595.043 c 39.522 595.359 39.078 595.543 38.631 595.543 c 38.185 595.543 37.741 595.359 37.425 595.043 c 37.109 594.727 36.925 594.283 36.925 593.837 c 36.925 593.390 37.109 592.946 37.425 592.630 c 37.741 592.314 38.185 592.130 38.631 592.130 c 39.078 592.130 39.522 592.314 39.838 592.630 c 40.154 592.946 40.337 593.390 40.337 593.837 c f BT 45.750 590.869 Td /F1 9.8 Tf [(Advanced Life Support within 8 minutes)] TJ ET 40.337 578.182 m 40.337 578.629 40.154 579.073 39.838 579.389 c 39.522 579.704 39.078 579.888 38.631 579.888 c 38.185 579.888 37.741 579.704 37.425 579.389 c 37.109 579.073 36.925 578.629 36.925 578.182 c 36.925 577.735 37.109 577.291 37.425 576.975 c 37.741 576.660 38.185 576.476 38.631 576.476 c 39.078 576.476 39.522 576.660 39.838 576.975 c 40.154 577.291 40.337 577.735 40.337 578.182 c f BT 45.750 575.214 Td /F1 9.8 Tf [(Evacuation to a medical facility within 30 minutes.)] TJ ET BT 26.250 552.060 Td /F1 9.8 Tf [(However these suggestions are based on only low patient numbers requiring triage, and arose from low-level evidence and )] TJ ET BT 26.250 540.155 Td /F1 9.8 Tf [(expert judgement, which the authors stressed is in need of further research )] TJ ET 0.267 0.267 0.267 rg BT 352.485 540.155 Td /F1 9.8 Tf [([28])] TJ ET 0.271 0.267 0.267 rg BT 368.748 540.155 Td /F1 9.8 Tf [( .)] TJ ET BT 26.250 520.750 Td /F1 9.8 Tf [(Event preplanning using these principles has been described by )] TJ ET 0.267 0.267 0.267 rg BT 304.808 520.750 Td /F1 9.8 Tf [([12])] TJ ET 0.271 0.267 0.267 rg BT 321.070 520.750 Td /F1 9.8 Tf [( in relation to the 2010 Love Parade in Germany when )] TJ ET BT 26.250 508.845 Td /F1 9.8 Tf [(major medical preparations were put in place. They reported on patient care delivery at this mass gathering, where following a )] TJ ET BT 26.250 496.941 Td /F1 9.8 Tf [(stampede, 21 died and over 510 were injured. Once a disaster was called at the site, additional emergency healthcare )] TJ ET BT 26.250 485.036 Td /F1 9.8 Tf [(personnel were brought in, and extra treatment facilities were created to deal with the situation. First-aid posts and emergency )] TJ ET BT 26.250 473.131 Td /F1 9.8 Tf [(treatment and triage stations were set up on site, dealing with a high volume of patients. The formation of trauma teams made it )] TJ ET BT 26.250 461.226 Td /F1 9.8 Tf [(possible to control patient flows appropriately to all hospitals. However, even with such well planned emergency response, )] TJ ET BT 26.250 449.322 Td /F1 9.8 Tf [(adverse consequences occurred which demonstrates again the complexity of planning for such mass gathering events.)] TJ ET BT 26.250 412.719 Td /F4 12.0 Tf [(Summary)] TJ ET BT 26.250 392.765 Td /F1 9.8 Tf [(Mass gathering events have a potential to place a severe strain on the local health care system, with a mixture of high crowd )] TJ ET BT 26.250 380.860 Td /F1 9.8 Tf [(density, restricted points of access, limited crowd control and lack of sufficient on-site medical care and emergency response )] TJ ET BT 26.250 368.955 Td /F1 9.8 Tf [(can increase the risk of disaster.)] TJ ET BT 26.250 349.551 Td /F1 9.8 Tf [(Many challenges are faced by mass gathering event organisers, medical resource planners, and emergency services, including )] TJ ET BT 26.250 337.646 Td /F1 9.8 Tf [(local hospital emergency departments in order to provide a safe event. Analysis of previous crowd disasters indicates a need for )] TJ ET BT 26.250 325.741 Td /F1 9.8 Tf [(early detailed planning of crowd policies, evacuation procedures and involvement of emergency services which are necessary )] TJ ET BT 26.250 313.836 Td /F1 9.8 Tf [(to promote and provide a successful event. This review highlights several key considerations that could impact on health )] TJ ET BT 26.250 301.932 Td /F1 9.8 Tf [(resources include:)] TJ ET 40.337 285.495 m 40.337 285.941 40.154 286.385 39.838 286.701 c 39.522 287.017 39.078 287.201 38.631 287.201 c 38.185 287.201 37.741 287.017 37.425 286.701 c 37.109 286.385 36.925 285.941 36.925 285.495 c 36.925 285.048 37.109 284.604 37.425 284.288 c 37.741 283.972 38.185 283.788 38.631 283.788 c 39.078 283.788 39.522 283.972 39.838 284.288 c 40.154 284.604 40.337 285.048 40.337 285.495 c f BT 45.750 282.527 Td /F1 9.8 Tf [(Preplanning for mass gathering events is key and should include health management and major incident planning.)] TJ ET 40.337 269.840 m 40.337 270.286 40.154 270.730 39.838 271.046 c 39.522 271.362 39.078 271.546 38.631 271.546 c 38.185 271.546 37.741 271.362 37.425 271.046 c 37.109 270.730 36.925 270.286 36.925 269.840 c 36.925 269.393 37.109 268.949 37.425 268.633 c 37.741 268.317 38.185 268.134 38.631 268.134 c 39.078 268.134 39.522 268.317 39.838 268.633 c 40.154 268.949 40.337 269.393 40.337 269.840 c f BT 45.750 266.872 Td /F1 9.8 Tf [(Adequate crowd security and emergency medical services need to be provided at a mass gatherings taking account of )] TJ ET BT 45.750 254.967 Td /F1 9.8 Tf [(crowd size and factors such as event type and external environmental conditions.)] TJ ET 40.337 242.280 m 40.337 242.727 40.154 243.171 39.838 243.487 c 39.522 243.803 39.078 243.987 38.631 243.987 c 38.185 243.987 37.741 243.803 37.425 243.487 c 37.109 243.171 36.925 242.727 36.925 242.280 c 36.925 241.834 37.109 241.390 37.425 241.074 c 37.741 240.758 38.185 240.574 38.631 240.574 c 39.078 240.574 39.522 240.758 39.838 241.074 c 40.154 241.390 40.337 241.834 40.337 242.280 c f BT 45.750 239.313 Td /F1 9.8 Tf [(Emergency Medical Services with adequate training and experience, in the management of multiple medical casualties )] TJ ET BT 45.750 227.408 Td /F1 9.8 Tf [(need to be available. Pre-planning with local hospitals will aid the emergency response.)] TJ ET 40.337 214.721 m 40.337 215.167 40.154 215.611 39.838 215.927 c 39.522 216.243 39.078 216.427 38.631 216.427 c 38.185 216.427 37.741 216.243 37.425 215.927 c 37.109 215.611 36.925 215.167 36.925 214.721 c 36.925 214.274 37.109 213.830 37.425 213.514 c 37.741 213.198 38.185 213.015 38.631 213.015 c 39.078 213.015 39.522 213.198 39.838 213.514 c 40.154 213.830 40.337 214.274 40.337 214.721 c f BT 45.750 211.753 Td /F1 9.8 Tf [(Health planning should include: )] TJ ET 0.39 w 1 J 1 j 59.837 199.066 m 59.837 199.513 59.654 199.957 59.338 200.273 c 59.022 200.588 58.578 200.772 58.131 200.772 c 57.685 200.772 57.241 200.588 56.925 200.273 c 56.609 199.957 56.425 199.513 56.425 199.066 c 56.425 198.619 56.609 198.175 56.925 197.859 c 57.241 197.544 57.685 197.360 58.131 197.360 c 58.578 197.360 59.022 197.544 59.338 197.859 c 59.654 198.175 59.837 198.619 59.837 199.066 c s BT 65.250 196.098 Td /F1 9.8 Tf [(Training of stewards and security staff in crowd control)] TJ ET 0.39 w 1 J 1 j 59.837 183.411 m 59.837 183.858 59.654 184.302 59.338 184.618 c 59.022 184.934 58.578 185.118 58.131 185.118 c 57.685 185.118 57.241 184.934 56.925 184.618 c 56.609 184.302 56.425 183.858 56.425 183.411 c 56.425 182.965 56.609 182.521 56.925 182.205 c 57.241 181.889 57.685 181.705 58.131 181.705 c 58.578 181.705 59.022 181.889 59.338 182.205 c 59.654 182.521 59.837 182.965 59.837 183.411 c s BT 65.250 180.444 Td /F1 9.8 Tf [(An adequate ticketing system to limit overcrowding)] TJ ET 0.39 w 1 J 1 j 59.837 167.757 m 59.837 168.203 59.654 168.647 59.338 168.963 c 59.022 169.279 58.578 169.463 58.131 169.463 c 57.685 169.463 57.241 169.279 56.925 168.963 c 56.609 168.647 56.425 168.203 56.425 167.757 c 56.425 167.310 56.609 166.866 56.925 166.550 c 57.241 166.234 57.685 166.050 58.131 166.050 c 58.578 166.050 59.022 166.234 59.338 166.550 c 59.654 166.866 59.837 167.310 59.837 167.757 c s BT 65.250 164.789 Td /F1 9.8 Tf [(A functioning and adequate public address system)] TJ ET 0.39 w 1 J 1 j 59.837 152.102 m 59.837 152.548 59.654 152.992 59.338 153.308 c 59.022 153.624 58.578 153.808 58.131 153.808 c 57.685 153.808 57.241 153.624 56.925 153.308 c 56.609 152.992 56.425 152.548 56.425 152.102 c 56.425 151.655 56.609 151.211 56.925 150.895 c 57.241 150.579 57.685 150.396 58.131 150.396 c 58.578 150.396 59.022 150.579 59.338 150.895 c 59.654 151.211 59.837 151.655 59.837 152.102 c s BT 65.250 149.134 Td /F1 9.8 Tf [(Specified entrance and exit points to an event to help ensure a unidirectional flow of crowd)] TJ ET 40.337 132.697 m 40.337 133.144 40.154 133.588 39.838 133.904 c 39.522 134.219 39.078 134.403 38.631 134.403 c 38.185 134.403 37.741 134.219 37.425 133.904 c 37.109 133.588 36.925 133.144 36.925 132.697 c 36.925 132.250 37.109 131.806 37.425 131.490 c 37.741 131.175 38.185 130.991 38.631 130.991 c 39.078 130.991 39.522 131.175 39.838 131.490 c 40.154 131.806 40.337 132.250 40.337 132.697 c f BT 45.750 129.729 Td /F1 9.8 Tf [(Evacuation plans including fire safety should be available for all mass gathering events with information passed on to )] TJ ET BT 45.750 117.825 Td /F1 9.8 Tf [(attendees in a clear fashion. Exit routes should be clear and free from obstruction, and plans should be in place for co-)] TJ ET BT 45.750 105.920 Td /F1 9.8 Tf [(ordinated and safe evacuation.)] TJ ET 40.337 93.233 m 40.337 93.679 40.154 94.123 39.838 94.439 c 39.522 94.755 39.078 94.939 38.631 94.939 c 38.185 94.939 37.741 94.755 37.425 94.439 c 37.109 94.123 36.925 93.679 36.925 93.233 c 36.925 92.786 37.109 92.342 37.425 92.026 c 37.741 91.710 38.185 91.527 38.631 91.527 c 39.078 91.527 39.522 91.710 39.838 92.026 c 40.154 92.342 40.337 92.786 40.337 93.233 c f BT 45.750 90.265 Td /F1 9.8 Tf [(Every mass gathering event should have a major incident and mass casualty plan which should be activated in the event of )] TJ ET BT 45.750 78.360 Td /F1 9.8 Tf [(a disaster.)] TJ ET BT 26.250 55.206 Td /F1 9.8 Tf [(Further studies of mass gathering events are warranted to advance not only the epidemiological knowledge base, but also to )] TJ ET BT 26.250 43.301 Td /F1 9.8 Tf [(gain further lessons of emergency preparedness and response.)] TJ ET Q q 0.000 0.000 0.000 rg BT 291.710 19.825 Td /F1 11.0 Tf [(5)] TJ ET BT 25.000 19.825 Td /F1 11.0 Tf [(PLOS Currents Disasters)] TJ ET 0.39 w 1 J 1 j Q endstream endobj 217 0 obj << /Type /Annot /Subtype /Link /A 218 0 R /Border [0 0 0] /H /I /Rect [ 549.1327 703.9553 565.3958 713.8759 ] >> endobj 218 0 obj << /Type /Action >> endobj 219 0 obj << /Type /Annot /Subtype /Link /A 220 0 R /Border [0 0 0] /H /I /Rect [ 321.5872 692.0506 337.8502 701.9712 ] >> endobj 220 0 obj << /Type /Action >> endobj 221 0 obj << /Type /Annot /Subtype /Link /A 222 0 R /Border [0 0 0] /H /I /Rect [ 497.1750 692.0506 513.4380 701.9712 ] >> endobj 222 0 obj << /Type /Action >> endobj 223 0 obj << /Type /Annot /Subtype /Link /A 224 0 R /Border [0 0 0] /H /I /Rect [ 170.3843 680.1458 186.6473 690.0665 ] >> endobj 224 0 obj << /Type /Action >> endobj 225 0 obj << /Type /Annot /Subtype /Link /A 226 0 R /Border [0 0 0] /H /I /Rect [ 291.7815 668.2411 308.0445 678.1617 ] >> 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Football stadia disasters in the united kingdom, learning from tragedy? Organisation Environment )] TJ ET BT 26.250 287.678 Td /F1 9.8 Tf [(1993;7:205-229)] TJ ET BT 26.250 268.273 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 268.273 Td /F1 9.8 Tf [(Ahmed QA, Arabi YM, Memish ZA. Health Risks at the Hajj. Lancet 2006;367:1008-1015)] TJ ET BT 26.250 248.868 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 248.868 Td /F1 9.8 Tf [(Garcia LM. Pathological Crowds: Affect and danger in responses to the Love Parade disaster at Duisburg. Dancecult. )] TJ ET BT 26.250 236.964 Td /F1 9.8 Tf [(Journal of Electronic Dance Music Culture. 2011;2;html https://www.dj.dancecult.net/index.php/journal/article/view/66/102)] TJ ET BT 26.250 217.559 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 217.559 Td /F1 9.8 Tf [(Ackermann O, Lahm A, Pfohl M, Kother B, Lian TK, Kutzerm Weber M, Marx F, Vogel T. Hax P-M. Patient care at the 2010 )] TJ ET BT 26.250 205.654 Td /F1 9.8 Tf [(Love Parade in Duisburg Germany. Dtsch Arztebl int 2011; 108:483-489)] TJ ET BT 26.250 186.249 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 186.249 Td /F1 9.8 Tf [(Martin TE. The Ramstein Airshow Disaster. J R Army Med Corps 1990;136:19-26)] TJ ET BT 26.250 166.845 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 166.845 Td /F1 9.8 Tf [(Hsu, EB. Human Stampede: An Unexamined Threat. Emergency physicians Monthly 2011)] TJ ET BT 26.250 147.440 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 147.440 Td /F1 9.8 Tf [(Report of the Tribunal of Inquiry on the fire at the Stardust, Artane, Dublin on the 14th February, 1981. by Tribunal of Inquiry )] TJ ET BT 26.250 135.535 Td /F1 9.8 Tf [(on the Fire at the Stardust, Artane, Dublin on the 14th February, 1981 \(Ireland\) Published in 1982, Published by the Stationary )] TJ ET BT 26.250 123.630 Td /F1 9.8 Tf [(Office \(Dublin\). https://www.lenus.ie/hse/bitstream/10147/45478/1/7964.pdf)] TJ ET BT 26.250 104.226 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 104.226 Td /F1 9.8 Tf [(Popplewell, Mr Justice O. 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Report RO )] TJ ET Q q 15.000 39.226 577.500 737.774 re W n 0.271 0.267 0.267 rg BT 26.250 750.278 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 730.324 Td /F1 9.8 Tf [(The authors have declared that no competing interests exist.)] TJ ET BT 26.250 693.722 Td /F4 12.0 Tf [(Abbreviations)] TJ ET BT 26.250 673.767 Td /F1 9.8 Tf [(DMAT Public Health Service Disaster Medical Assistance Teams;)] TJ ET BT 26.250 654.363 Td /F1 9.8 Tf [(EMS Emergency Medical Services;)] TJ ET BT 26.250 634.958 Td /F1 9.8 Tf [(NAEMSP National Association of EMS Physicians;)] TJ ET BT 26.250 615.553 Td /F1 9.8 Tf [(UNISDR United Nations Strategy for Disaster Reduction)] TJ ET BT 26.250 578.951 Td /F4 12.0 Tf [(Acknowledgements)] TJ ET BT 26.250 558.996 Td /F1 9.8 Tf [(With thanks to Mark Nunn of the World Health Organisation and Mark Salter at the Health Protection Agency UK.)] TJ ET BT 26.250 529.894 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 502.440 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 502.440 Td /F1 9.8 Tf [(De Lorenzo RA. Mass gathering medicine: a review. Prehosp Disaster Med 1997;12:68-72)] TJ ET BT 26.250 483.035 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 483.035 Td /F1 9.8 Tf [(World Health Organisation. Communicable disease alert and response for mass gatherings: key considerations. June 2008)] TJ ET BT 26.250 463.630 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 463.630 Td /F1 9.8 Tf [(Milsten Am, Maguire BJ, Bissell RA, Seaman KG. Mass-Gathering Medical Care: A Review of the Literature. Prehosp Disast )] TJ ET BT 26.250 451.725 Td /F1 9.8 Tf [(Med 2002;17:151-162)] TJ ET BT 26.250 432.321 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 432.321 Td /F1 9.8 Tf [(Arbon P, Bridgewater FH, Smith C. Mass gathering medicine: a predictive model for patient presentation and transport rates. )] TJ ET BT 26.250 420.416 Td /F1 9.8 Tf [(Prehosp Disaster Med 2001;16:150-158)] TJ ET BT 26.250 401.011 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 401.011 Td /F1 9.8 Tf [(Ngoepe Mr Justice B. Final Report Commission of Inquiry into the Ellis Park Stadium Soccer Disaster of 11 April 2001. )] TJ ET BT 26.250 389.106 Td /F1 9.8 Tf [(https://www.info.gov.za/view/DownloadFileAction?id=70241)] TJ ET BT 26.250 369.702 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 369.702 Td /F1 9.8 Tf [(Deleany JS, Drummond R. Mass casualties and triage at a sporting event. Br J Sports Med 2002;36:85-88)] TJ ET BT 26.250 350.297 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 350.297 Td /F1 9.8 Tf [(Taylor, Lord Justice. Final Report into the Hillsborough Stadium Disaster, CM 962. London, HMSO. 1990.)] TJ ET BT 26.250 330.892 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 330.892 Td /F1 9.8 Tf [(Weir, I. Findings and Recommendations by the Coronial Inquest into the Death of Jessica Michalik. 2002;1-15 )] TJ ET BT 26.250 318.987 Td /F1 9.8 Tf [(https://www.crowdsafe.com/BDOInquestreportWeirFINAL120802.pdf)] TJ ET BT 26.250 299.583 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 299.583 Td /F1 9.8 Tf [(Eliott D, Smith D. Football stadia disasters in the united kingdom, learning from tragedy? Organisation Environment )] TJ ET BT 26.250 287.678 Td /F1 9.8 Tf [(1993;7:205-229)] TJ ET BT 26.250 268.273 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 268.273 Td /F1 9.8 Tf [(Ahmed QA, Arabi YM, Memish ZA. Health Risks at the Hajj. Lancet 2006;367:1008-1015)] TJ ET BT 26.250 248.868 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 248.868 Td /F1 9.8 Tf [(Garcia LM. Pathological Crowds: Affect and danger in responses to the Love Parade disaster at Duisburg. Dancecult. )] TJ ET BT 26.250 236.964 Td /F1 9.8 Tf [(Journal of Electronic Dance Music Culture. 2011;2;html https://www.dj.dancecult.net/index.php/journal/article/view/66/102)] TJ ET BT 26.250 217.559 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 217.559 Td /F1 9.8 Tf [(Ackermann O, Lahm A, Pfohl M, Kother B, Lian TK, Kutzerm Weber M, Marx F, Vogel T. Hax P-M. Patient care at the 2010 )] TJ ET BT 26.250 205.654 Td /F1 9.8 Tf [(Love Parade in Duisburg Germany. Dtsch Arztebl int 2011; 108:483-489)] TJ ET BT 26.250 186.249 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 186.249 Td /F1 9.8 Tf [(Martin TE. The Ramstein Airshow Disaster. J R Army Med Corps 1990;136:19-26)] TJ ET BT 26.250 166.845 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 166.845 Td /F1 9.8 Tf [(Hsu, EB. Human Stampede: An Unexamined Threat. Emergency physicians Monthly 2011)] TJ ET BT 26.250 147.440 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 147.440 Td /F1 9.8 Tf [(Report of the Tribunal of Inquiry on the fire at the Stardust, Artane, Dublin on the 14th February, 1981. by Tribunal of Inquiry )] TJ ET BT 26.250 135.535 Td /F1 9.8 Tf [(on the Fire at the Stardust, Artane, Dublin on the 14th February, 1981 \(Ireland\) Published in 1982, Published by the Stationary )] TJ ET BT 26.250 123.630 Td /F1 9.8 Tf [(Office \(Dublin\). https://www.lenus.ie/hse/bitstream/10147/45478/1/7964.pdf)] TJ ET BT 26.250 104.226 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 104.226 Td /F1 9.8 Tf [(Popplewell, Mr Justice O. Committee of Inquiry into Crowd Safety and Control at Sports Grounds. Final Report. Cmnd 9710 )] TJ ET BT 26.250 92.321 Td /F1 9.8 Tf [(Jan. London, HMSO. 1986)] TJ ET BT 26.250 72.916 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 72.916 Td /F1 9.8 Tf [(Moddie M. Accidents and Missed Lessons. Frontline 2004;16:13-14)] TJ ET BT 26.250 53.511 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 53.511 Td /F1 9.8 Tf [(Eksborg A-L, Elinder H, Mansfield J, Sigfridsson S-E, Widlund P. Fire in Gothenburg. 1998 October 29-30. Report RO )] TJ ET Q q 15.000 39.226 577.500 737.774 re W n 0.271 0.267 0.267 rg BT 26.250 750.278 Td /F4 12.0 Tf [(Competing Interests)] TJ ET BT 26.250 730.324 Td /F1 9.8 Tf [(The authors have declared that no competing interests exist.)] TJ ET BT 26.250 693.722 Td /F4 12.0 Tf [(Abbreviations)] TJ ET BT 26.250 673.767 Td /F1 9.8 Tf [(DMAT Public Health Service Disaster Medical Assistance Teams;)] TJ ET BT 26.250 654.363 Td /F1 9.8 Tf [(EMS Emergency Medical Services;)] TJ ET BT 26.250 634.958 Td /F1 9.8 Tf [(NAEMSP National Association of EMS Physicians;)] TJ ET BT 26.250 615.553 Td /F1 9.8 Tf [(UNISDR United Nations Strategy for Disaster Reduction)] TJ ET BT 26.250 578.951 Td /F4 12.0 Tf [(Acknowledgements)] TJ ET BT 26.250 558.996 Td /F1 9.8 Tf [(With thanks to Mark Nunn of the World Health Organisation and Mark Salter at the Health Protection Agency UK.)] TJ ET BT 26.250 529.894 Td /F4 12.0 Tf [(References)] TJ ET BT 26.250 502.440 Td /F1 9.8 Tf [(1.)] TJ ET BT 38.132 502.440 Td /F1 9.8 Tf [(De Lorenzo RA. Mass gathering medicine: a review. Prehosp Disaster Med 1997;12:68-72)] TJ ET BT 26.250 483.035 Td /F1 9.8 Tf [(2.)] TJ ET BT 38.132 483.035 Td /F1 9.8 Tf [(World Health Organisation. Communicable disease alert and response for mass gatherings: key considerations. June 2008)] TJ ET BT 26.250 463.630 Td /F1 9.8 Tf [(3.)] TJ ET BT 38.132 463.630 Td /F1 9.8 Tf [(Milsten Am, Maguire BJ, Bissell RA, Seaman KG. Mass-Gathering Medical Care: A Review of the Literature. Prehosp Disast )] TJ ET BT 26.250 451.725 Td /F1 9.8 Tf [(Med 2002;17:151-162)] TJ ET BT 26.250 432.321 Td /F1 9.8 Tf [(4.)] TJ ET BT 38.132 432.321 Td /F1 9.8 Tf [(Arbon P, Bridgewater FH, Smith C. Mass gathering medicine: a predictive model for patient presentation and transport rates. )] TJ ET BT 26.250 420.416 Td /F1 9.8 Tf [(Prehosp Disaster Med 2001;16:150-158)] TJ ET BT 26.250 401.011 Td /F1 9.8 Tf [(5.)] TJ ET BT 38.132 401.011 Td /F1 9.8 Tf [(Ngoepe Mr Justice B. Final Report Commission of Inquiry into the Ellis Park Stadium Soccer Disaster of 11 April 2001. )] TJ ET BT 26.250 389.106 Td /F1 9.8 Tf [(https://www.info.gov.za/view/DownloadFileAction?id=70241)] TJ ET BT 26.250 369.702 Td /F1 9.8 Tf [(6.)] TJ ET BT 38.132 369.702 Td /F1 9.8 Tf [(Deleany JS, Drummond R. Mass casualties and triage at a sporting event. Br J Sports Med 2002;36:85-88)] TJ ET BT 26.250 350.297 Td /F1 9.8 Tf [(7.)] TJ ET BT 38.132 350.297 Td /F1 9.8 Tf [(Taylor, Lord Justice. Final Report into the Hillsborough Stadium Disaster, CM 962. London, HMSO. 1990.)] TJ ET BT 26.250 330.892 Td /F1 9.8 Tf [(8.)] TJ ET BT 38.132 330.892 Td /F1 9.8 Tf [(Weir, I. Findings and Recommendations by the Coronial Inquest into the Death of Jessica Michalik. 2002;1-15 )] TJ ET BT 26.250 318.987 Td /F1 9.8 Tf [(https://www.crowdsafe.com/BDOInquestreportWeirFINAL120802.pdf)] TJ ET BT 26.250 299.583 Td /F1 9.8 Tf [(9.)] TJ ET BT 38.132 299.583 Td /F1 9.8 Tf [(Eliott D, Smith D. Football stadia disasters in the united kingdom, learning from tragedy? Organisation Environment )] TJ ET BT 26.250 287.678 Td /F1 9.8 Tf [(1993;7:205-229)] TJ ET BT 26.250 268.273 Td /F1 9.8 Tf [(10.)] TJ ET BT 43.553 268.273 Td /F1 9.8 Tf [(Ahmed QA, Arabi YM, Memish ZA. Health Risks at the Hajj. Lancet 2006;367:1008-1015)] TJ ET BT 26.250 248.868 Td /F1 9.8 Tf [(11.)] TJ ET BT 43.553 248.868 Td /F1 9.8 Tf [(Garcia LM. Pathological Crowds: Affect and danger in responses to the Love Parade disaster at Duisburg. Dancecult. )] TJ ET BT 26.250 236.964 Td /F1 9.8 Tf [(Journal of Electronic Dance Music Culture. 2011;2;html https://www.dj.dancecult.net/index.php/journal/article/view/66/102)] TJ ET BT 26.250 217.559 Td /F1 9.8 Tf [(12.)] TJ ET BT 43.553 217.559 Td /F1 9.8 Tf [(Ackermann O, Lahm A, Pfohl M, Kother B, Lian TK, Kutzerm Weber M, Marx F, Vogel T. Hax P-M. Patient care at the 2010 )] TJ ET BT 26.250 205.654 Td /F1 9.8 Tf [(Love Parade in Duisburg Germany. Dtsch Arztebl int 2011; 108:483-489)] TJ ET BT 26.250 186.249 Td /F1 9.8 Tf [(13.)] TJ ET BT 43.553 186.249 Td /F1 9.8 Tf [(Martin TE. The Ramstein Airshow Disaster. J R Army Med Corps 1990;136:19-26)] TJ ET BT 26.250 166.845 Td /F1 9.8 Tf [(14.)] TJ ET BT 43.553 166.845 Td /F1 9.8 Tf [(Hsu, EB. Human Stampede: An Unexamined Threat. Emergency physicians Monthly 2011)] TJ ET BT 26.250 147.440 Td /F1 9.8 Tf [(15.)] TJ ET BT 43.553 147.440 Td /F1 9.8 Tf [(Report of the Tribunal of Inquiry on the fire at the Stardust, Artane, Dublin on the 14th February, 1981. by Tribunal of Inquiry )] TJ ET BT 26.250 135.535 Td /F1 9.8 Tf [(on the Fire at the Stardust, Artane, Dublin on the 14th February, 1981 \(Ireland\) Published in 1982, Published by the Stationary )] TJ ET BT 26.250 123.630 Td /F1 9.8 Tf [(Office \(Dublin\). https://www.lenus.ie/hse/bitstream/10147/45478/1/7964.pdf)] TJ ET BT 26.250 104.226 Td /F1 9.8 Tf [(16.)] TJ ET BT 43.553 104.226 Td /F1 9.8 Tf [(Popplewell, Mr Justice O. Committee of Inquiry into Crowd Safety and Control at Sports Grounds. Final Report. Cmnd 9710 )] TJ ET BT 26.250 92.321 Td /F1 9.8 Tf [(Jan. London, HMSO. 1986)] TJ ET BT 26.250 72.916 Td /F1 9.8 Tf [(17.)] TJ ET BT 43.553 72.916 Td /F1 9.8 Tf [(Moddie M. Accidents and Missed Lessons. Frontline 2004;16:13-14)] TJ ET BT 26.250 53.511 Td /F1 9.8 Tf [(18.)] TJ ET BT 43.553 53.511 Td /F1 9.8 Tf [(Eksborg A-L, Elinder H, Mansfield J, Sigfridsson S-E, Widlund P. Fire in Gothenburg. 1998 October 29-30. 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